Provider Demographics
NPI:1154350296
Name:W SAM WILLIAMS JR MD PA
Entity type:Organization
Organization Name:W SAM WILLIAMS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFORD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-771-3311
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:TX
Mailing Address - Zip Code:77962-1210
Mailing Address - Country:US
Mailing Address - Phone:361-771-3311
Mailing Address - Fax:361-771-3081
Practice Address - Street 1:204 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:TX
Practice Address - Zip Code:77962-1210
Practice Address - Country:US
Practice Address - Phone:361-771-3311
Practice Address - Fax:361-771-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00125TMedicare PIN