Provider Demographics
NPI:1356469191
Name:ALBERT M WILLIAMS
Entity Type:Organization
Organization Name:ALBERT M WILLIAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:508-990-0017
Mailing Address - Street 1:1 DEERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5004
Mailing Address - Country:US
Mailing Address - Phone:508-990-0017
Mailing Address - Fax:508-997-3006
Practice Address - Street 1:1 DEERFIELD LN
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5004
Practice Address - Country:US
Practice Address - Phone:508-990-0017
Practice Address - Fax:508-997-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1714813343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1714813Medicaid