1790740603 NPI number — WILLIAM WATSON WEBB M.D., PH D

Table of content: (NPI 1922343904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790740603 NPI number — WILLIAM WATSON WEBB M.D., PH D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
WILLIAM
Provider Middle Name:
WATSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH 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:
1790740603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 JOHN ST
Provider Second Line Business Mailing Address:
BOX 42
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49007-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-349-2266
Provider Business Mailing Address Fax Number:
269-349-0792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3304 COOLEY COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-349-2266
Provider Business Practice Location Address Fax Number:
269-349-0792
Provider Enumeration Date:
04/20/2006

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: 207RG0100X , with the licence number:  WW054328 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1790740603 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4307839 . This is a "KALAMAZOO COUNTY HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0M92920007 . This is a "MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 123693 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1790740603 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100C914640 . This is a "BCBS 04/25/2008 AND AFTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104307839 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383309299059 . This is a "CARESOURCE MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 100C910690 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1417961137 . This is a "BCBSM - BRONSON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P56360003 . This is a "MEDICARE 04/25/2008" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1851569958 . This is a "GROUP NPI 04/25/2008 AND AFTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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