Provider Demographics
NPI:1104981018
Name:WILLIAMS PRIMARY CARE PC
Entity type:Organization
Organization Name:WILLIAMS PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-836-4705
Mailing Address - Street 1:71 HOLLOWCREST DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657
Mailing Address - Country:US
Mailing Address - Phone:570-836-4705
Mailing Address - Fax:
Practice Address - Street 1:71 HOLLOWCREST DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657
Practice Address - Country:US
Practice Address - Phone:570-836-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001972184Medicaid
PA068646Medicare ID - Type Unspecified