1205946183 NPI number — JAR ENTERPRICES INC

Table of content: NICOLE GENEVIEVE WILLIAMS MD (NPI 1083936660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205946183 NPI number — JAR ENTERPRICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAR ENTERPRICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205946183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 PLEASANTON RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78221-1321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-922-0016
Provider Business Mailing Address Fax Number:
210-922-0261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 PLEASANTON RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78221-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-922-0016
Provider Business Practice Location Address Fax Number:
210-922-0261
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
210-922-0016

Provider Taxonomy Codes

  • Taxonomy code: 2471M1202X , with the licence number:  J9298 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 154887701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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