1780034561 NPI number — J WILLIAMS ENT, LLC

Table of content: (NPI 1780034561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780034561 NPI number — J WILLIAMS ENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J WILLIAMS ENT, LLC
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:
1780034561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9120 NE VANCOUVER MALL LOOP
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98662-6353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-253-6028
Provider Business Mailing Address Fax Number:
360-253-6029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9120 NE VANCOUVER MALL LOOP
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98662-6353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-253-6028
Provider Business Practice Location Address Fax Number:
360-253-6029
Provider Enumeration Date:
06/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
FRANCHISE OWNER
Authorized Official Telephone Number:
360-253-6028

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  IHS.FS.00000031 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 618263800 . This is a "FECA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com