1275640807 NPI number — JAMES E, WILLIAMS

Table of content: (NPI 1275640807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275640807 NPI number — JAMES E, WILLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES E, WILLIAMS
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:
1275640807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6800 BRENTWOOD STAIR RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76112-3349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-496-1961
Provider Business Mailing Address Fax Number:
817-451-0155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 BRENTWOOD STAIR RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76112-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-496-1961
Provider Business Practice Location Address Fax Number:
817-451-0155
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
817-496-1961

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  12829 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080231601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com