1831218205 NPI number — T K WILLIAMS PC

Table of content: (NPI 1831218205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831218205 NPI number — T K WILLIAMS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T K WILLIAMS PC
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:
1831218205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8450 HICKMAN RD
Provider Second Line Business Mailing Address:
STE 14
Provider Business Mailing Address City Name:
CLIVE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50325-4313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-276-9441
Provider Business Mailing Address Fax Number:
515-243-0948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8450 HICKMAN RD
Provider Second Line Business Practice Location Address:
STE 14
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-276-9441
Provider Business Practice Location Address Fax Number:
515-243-0948
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TRACI
Authorized Official Middle Name:
KIP
Authorized Official Title or Position:
PRESIDENT-PHYSICIAN
Authorized Official Telephone Number:
515-276-9441

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  A05155 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 243089 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 44-00218 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 23229 . This is a "WELLMARK BLUE CROSS BLUE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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