Basic Information
| Provider Information | |||||||||
| NPI: | 1376647453 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENERAL VASCULAR SURGERY SPECIALIST P A | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | STEVEN C WILLIAMS MD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 ASTON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 ASTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | CHARLES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6016842481 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 09423 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1317934 | 01 | LA | LOUISIANA MEDICAID | OTHER | 770000345 | 01 | MS | RAILROAD MEDICARE | OTHER | 0055406 | 01 | MS | MISSISSIPPI SELECT | OTHER | 1730019 | 01 | MS | UNITED HEALTHCARE | OTHER | 0200000153 | 01 | MS | INDIVIDUAL MEDICARE PTAN | OTHER | 412909978A | 01 | MS | BLUECROSS BLUESHIELD | OTHER | 00115579 | 05 | MS | MEDICAID |