Provider Demographics
NPI:1346244787
Name:BILLS, PONCET COURTLAND (DO)
Entity Type:Individual
Prefix:
First Name:PONCET
Middle Name:COURTLAND
Last Name:BILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:503 5TH ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:OH
Practice Address - Zip Code:45715-8916
Practice Address - Country:US
Practice Address - Phone:740-984-2391
Practice Address - Fax:740-984-8834
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000120136OtherANTHEM
OH000000699797OtherANTHEM
OH010063626OtherRRMCR
OH0971480Medicaid
OH7418811Medicare PIN
OH000000120136OtherANTHEM
OHF08279Medicare UPIN