Basic Information
| Provider Information | |||||||||
| NPI: | 1356545099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM S. WITT, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 508 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404760508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022263858 | ||||||||
| FaxNumber: | 5022239829 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 MERCY CT | ||||||||
| Address2: | MARCUM & WALLACE HOSPITAL | ||||||||
| City: | IRVINE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403361331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067232115 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | WITT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5022263858 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 22069 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 65937377 | 05 | KY | MEDICAID | 000000232384 | 01 | KY | ANTHEM BLUE CROSS PIN | OTHER |