Provider Demographics
NPI: | 1497702344 |
---|---|
Name: | SIMON-WILLIAMSON CLINIC, P.C. |
Entity Type: | Organization |
Organization Name: | SIMON-WILLIAMSON CLINIC, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT OF SWC |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | KIRBY |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 205-397-8907 |
Mailing Address - Street 1: | 832 PRINCETON AVE SW |
Mailing Address - Street 2: | |
Mailing Address - City: | BIRMINGHAM |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35211-1320 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 205-780-7053 |
Mailing Address - Fax: | 205-397-4989 |
Practice Address - Street 1: | 832 PRINCETON AVE SW |
Practice Address - Street 2: | |
Practice Address - City: | BIRMINGHAM |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35211-1323 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-780-7053 |
Practice Address - Fax: | 205-397-4989 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-27 |
Last Update Date: | 2022-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
133V00000X, 207Q00000X, 207R00000X, 207RH0003X, 207U00000X, 207V00000X, 207W00000X, 208000000X, 213ES0131X, 2471M1202X, 363LF0000X, 363LP2300X, 367A00000X, 207R00000X | ||
AL | 207RR0500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | Group - Multi-Specialty |
No | 2471M1202X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 000060006 | Medicaid | |
AL | D436 | Other | MEDICARE |