Provider Demographics
NPI:1164503611
Name:SCOTT A WILLIAMS D O P C
Entity Type:Organization
Organization Name:SCOTT A WILLIAMS D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-225-2663
Mailing Address - Street 1:1901 W 3RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5205
Mailing Address - Country:US
Mailing Address - Phone:580-225-2663
Mailing Address - Fax:580-225-2373
Practice Address - Street 1:1901 W 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5205
Practice Address - Country:US
Practice Address - Phone:580-225-2663
Practice Address - Fax:580-225-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200091560BMedicaid
OK200091560BMedicaid
OK500522219Medicare PIN