1033169289 NPI number — MR. WILLIAM ALEXANDER MILLAR ABC

Table of content: MR. WILLIAM ALEXANDER MILLAR ABC (NPI 1033169289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033169289 NPI number — MR. WILLIAM ALEXANDER MILLAR ABC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLAR
Provider First Name:
WILLIAM
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ABC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLAR
Provider Other First Name:
WILLIAM
Provider Other Middle Name:
ALEXANDER
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ABC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033169289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 HOLLIDAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76301-4312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-322-4647
Provider Business Mailing Address Fax Number:
940-322-9806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 HOLLIDAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76301-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-322-4647
Provider Business Practice Location Address Fax Number:
940-322-9806
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225000000X , with the licence number:  21 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 514542 . This is a "BLUE CROSS IDENTIFIER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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