Provider Demographics
NPI:1962955864
Name:MCWILLIAMS FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:MCWILLIAMS FAMILY MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:936-582-0220
Mailing Address - Street 1:19782 HIGHWAY 105 W
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-3103
Mailing Address - Country:US
Mailing Address - Phone:936-582-0220
Mailing Address - Fax:
Practice Address - Street 1:19782 HIGHWAY 105 W
Practice Address - Street 2:SUITE 111
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-3103
Practice Address - Country:US
Practice Address - Phone:936-582-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D8210OtherMEDICARE PTAN/ID#