Basic Information
| Provider Information | |||||||||
| NPI: | 1912990953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANKS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 COMMERCE CROSSINGS DR FL 3 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402292182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022534977 | ||||||||
| FaxNumber: | 5024895751 | ||||||||
| Practice Location | |||||||||
| Address1: | 2108 NICHOLASVILLE RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592789413 | ||||||||
| FaxNumber: | 8592760715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34789 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0400997 | 01 | KY | UNITED HEALTHCARE | OTHER | 110224279 | 01 | KY | RAILROAD MEDICARE | OTHER | 611012421Y | 01 | KY | HUMANA | OTHER | 0000000200356 | 01 | KY | ANTHEM BLUE SHIELD | OTHER | 611012421 | 01 | KY | TPN CONTRACTS | OTHER | 611012421004 | 01 | KY | TRICARE CHAMPUS | OTHER | 611012421 | 01 | KY | AETNA | OTHER | H19626 | 01 | KY | BLUEGRASS HMO | OTHER | 0037675 | 01 | KY | MEDICARE - FAYETTE COUNTY HEALTH DEPARTMENT | OTHER | 64-018013 | 05 | KY | MEDICAID |