Provider Demographics
NPI:1073823522
Name:KELCEY L. WILLIAMS, MD, PLLC
Entity Type:Organization
Organization Name:KELCEY L. WILLIAMS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RENDERING PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELCEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-363-5779
Mailing Address - Street 1:2541 S IH 35 # 200-242
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7360
Mailing Address - Country:US
Mailing Address - Phone:512-363-5779
Mailing Address - Fax:512-292-4458
Practice Address - Street 1:2541 S IH 35 # 200-242
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7360
Practice Address - Country:US
Practice Address - Phone:512-363-5779
Practice Address - Fax:512-292-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7926208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB117522Medicare PIN