Basic Information
| Provider Information | |||||||||
| NPI: | 1407174154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | RC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1823 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857762800 | ||||||||
| FaxNumber: | 7855654754 | ||||||||
| Practice Location | |||||||||
| Address1: | 3073 WHITE MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038607101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2010 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20770 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 04-36775 | KS | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 06802332 | 01 | KS | MEDICARE PTAN 06802332 | OTHER |