1316901077 NPI number — DR. BETSY LU EL WILLIAMS PH D

Table of content: DR. BETSY LU EL WILLIAMS PH D (NPI 1316901077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316901077 NPI number — DR. BETSY LU EL WILLIAMS PH D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
BETSY
Provider Middle Name:
LU EL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1316901077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 PHOENIX NE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-872-2828
Provider Business Mailing Address Fax Number:
505-872-2828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 PHOENIX NE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-872-2828
Provider Business Practice Location Address Fax Number:
505-872-2828
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  1495 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X , with the licence number: 3370 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NM100133 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51608 . This is a "PRESBYTERIAN HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 15572 . This is a "LOVELACE HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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