Provider Demographics
NPI:1538118245
Name:ROGER TODD WILLIAMS MD PSC
Entity Type:Organization
Organization Name:ROGER TODD WILLIAMS MD PSC
Other - Org Name:DOCTORS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-773-3737
Mailing Address - Street 1:400 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-9512
Mailing Address - Country:US
Mailing Address - Phone:270-773-3737
Mailing Address - Fax:270-773-3738
Practice Address - Street 1:400 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127-9512
Practice Address - Country:US
Practice Address - Phone:270-773-3737
Practice Address - Fax:270-773-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37488261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64058233Medicaid
KY0000000299382OtherBC/BS PIN
KYDB3991OtherRAILROAD MEDICARE
KYDB3991OtherRAILROAD MEDICARE
KY7807Medicare PIN