1396367546 NPI number — MR. VESTER JOE WILLIAMS II PARAMEDIC

Table of content: MR. VESTER JOE WILLIAMS II PARAMEDIC (NPI 1396367546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396367546 NPI number — MR. VESTER JOE WILLIAMS II PARAMEDIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
VESTER
Provider Middle Name:
JOE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
PARAMEDIC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
VESTER
Provider Other Middle Name:
JOE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PARAMEDIC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396367546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 939
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNDS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74047-0939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-650-3161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E 9TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELEETKA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-650-3161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2020

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: 146L00000X , with the licence number:  54010 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com