Provider Demographics
NPI:1780637447
Name:WILLIAMS ORTHOTIC - PROSTHETIC, INC.
Entity Type:Organization
Organization Name:WILLIAMS ORTHOTIC - PROSTHETIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:850-385-6655
Mailing Address - Street 1:2360 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4318
Mailing Address - Country:US
Mailing Address - Phone:850-385-6655
Mailing Address - Fax:850-385-7198
Practice Address - Street 1:2360 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4318
Practice Address - Country:US
Practice Address - Phone:850-385-6655
Practice Address - Fax:850-385-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0128300001Medicare NSC