Provider Demographics
NPI:1194943290
Name:WILLIAMS FAMILY MEDICINE PC
Entity type:Organization
Organization Name:WILLIAMS FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-391-6623
Mailing Address - Street 1:9015 ARBOR ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2056
Mailing Address - Country:US
Mailing Address - Phone:402-391-6623
Mailing Address - Fax:402-391-6983
Practice Address - Street 1:9015 ARBOR ST
Practice Address - Street 2:SUITE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2056
Practice Address - Country:US
Practice Address - Phone:402-391-6623
Practice Address - Fax:402-391-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE40761601700Medicaid
NE88009OtherCOVENTRY
NE092156OtherMEDICARE ID TYPE UNSPECIFIED
NE01-00109OtherUNITED HEALTH CARE
NE88009OtherCOVENTRY