1568638385 NPI number — DR. ERNIE GLEN WILLIAMSON M.D.

Table of content: DR. ERNIE GLEN WILLIAMSON M.D. (NPI 1568638385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568638385 NPI number — DR. ERNIE GLEN WILLIAMSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
ERNIE
Provider Middle Name:
GLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1568638385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NORTH CENTRAL COMMUNITY HEALTH CENTER
Provider Second Line Business Mailing Address:
4000 JENNINGS STATION RD
Provider Business Mailing Address City Name:
PINE LAWN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63121-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-615-7900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NORTH CENTRAL COMMUNITY HEALTH CENTER
Provider Second Line Business Practice Location Address:
4000 JENNINGS STATION RD
Provider Business Practice Location Address City Name:
PINE LAWN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63121-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-615-7900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2008

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: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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