Provider Demographics
NPI:1114106481
Name:KELVIN R. WILLIAMS
Entity Type:Organization
Organization Name:KELVIN R. WILLIAMS
Other - Org Name:CLEAR CHOICE MEDICAL DISTRIBUTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-326-4714
Mailing Address - Street 1:8868 RESEARCH BLVD
Mailing Address - Street 2:STE 406
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6497
Mailing Address - Country:US
Mailing Address - Phone:512-326-4714
Mailing Address - Fax:512-326-4700
Practice Address - Street 1:8868 RESEARCH BLVD
Practice Address - Street 2:STE 406
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6497
Practice Address - Country:US
Practice Address - Phone:512-326-4714
Practice Address - Fax:512-326-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0076001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168772501Medicaid
TX168772501Medicaid