1821006032 NPI number — MARK WILLIAMS M.D., LLC

Table of content: (NPI 1821006032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821006032 NPI number — MARK WILLIAMS M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK WILLIAMS M.D., 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:
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:
1821006032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 436256
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40253-6256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-244-9355
Provider Business Mailing Address Fax Number:
502-244-9577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12010 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-9355
Provider Business Practice Location Address Fax Number:
502-244-9577
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
502-244-9355

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  34119 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000334878 . This is a "ANTHEM PROVIDER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5931697 . This is a "AETNA PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00202037 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: H10999 . This is a "UPIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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