Basic Information
| Provider Information | |||||||||
| NPI: | 1043258221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7239 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805370239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024899400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 PINE LAKE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685165497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024203500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 12/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 17887 | NE | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 03554 | 01 | NE | BLUE CROSS BLUE SHIELD | OTHER | 100146390A | 05 | KS | MEDICAID | 300012382 | 01 | NE | RR MEDICARE | OTHER | 0520999 | 05 | IA | MEDICAID | 7783150 | 05 | SD | MEDICAID |