1598711087 NPI number — WILLIAMS FAMILY MEDICINE, P.A.

Table of content: (NPI 1598711087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598711087 NPI number — WILLIAMS FAMILY MEDICINE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMS FAMILY MEDICINE, P.A.
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:
1598711087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67201-8514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-248-9693
Provider Business Mailing Address Fax Number:
913-248-9383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67042-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-320-3100
Provider Business Practice Location Address Fax Number:
316-321-2188
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
316-320-3100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  05-27831 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com