Provider Demographics
NPI:1063698975
Name:WILLIAM P CHRISTIE III A PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:WILLIAM P CHRISTIE III A PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:512-398-5237
Mailing Address - Street 1:315 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2714
Mailing Address - Country:US
Mailing Address - Phone:512-398-5237
Mailing Address - Fax:512-398-7374
Practice Address - Street 1:315 HICKORY ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2714
Practice Address - Country:US
Practice Address - Phone:512-398-5237
Practice Address - Fax:512-398-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2754320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0883621-01Medicaid