Provider Demographics
NPI:1033205315
Name:WILLIAMSON, JAMES SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SCOTT
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-1433
Mailing Address - Country:US
Mailing Address - Phone:217-265-3146
Mailing Address - Fax:
Practice Address - Street 1:721 E COURT ST
Practice Address - Street 2:PARIS COMMUNITY HOSPITAL
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944
Practice Address - Country:US
Practice Address - Phone:217-465-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858455367500000X
IL209.007081367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07359093Medicaid
MSQ62399Medicare UPIN
MS07359093Medicaid