Provider Demographics
NPI:1215985148
Name:BARNES, WILLIAM EDRIS II (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDRIS
Last Name:BARNES
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:EDRIS
Other - Last Name:BARNES
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:141 HOSPITAL DRIVE
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-0347
Mailing Address - Country:US
Mailing Address - Phone:270-988-3298
Mailing Address - Fax:270-988-4642
Practice Address - Street 1:141 HOSPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-8043
Practice Address - Country:US
Practice Address - Phone:270-988-3298
Practice Address - Fax:270-988-4642
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21949208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64219496Medicaid
KYK011260Medicare PIN
KY64219496Medicaid
KY0627203Medicare PIN
KY0627403Medicare PIN
KY020044989Medicare PIN
KY3317421Medicare PIN
KY0627302Medicare PIN
KY0627412Medicare PIN