1982639712 NPI number — LARRY V WILLIAMS M.D.

Table of content: LARRY V WILLIAMS M.D. (NPI 1982639712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982639712 NPI number — LARRY V WILLIAMS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LARRY
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1982639712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47250-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-273-7700
Provider Business Mailing Address Fax Number:
812-273-2827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 CLIFTY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47250-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-273-7700
Provider Business Practice Location Address Fax Number:
812-273-2827
Provider Enumeration Date:
07/11/2006

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:  01023516 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100148550A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000042196 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 110184012 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 265769 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410013P . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 4370909 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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