Provider Demographics
NPI:1982633871
Name:WILLIAM O. KEARSE MD
Entity Type:Organization
Organization Name:WILLIAM O. KEARSE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINOJOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-761-0333
Mailing Address - Street 1:PO BOX 16304
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79490-6304
Mailing Address - Country:US
Mailing Address - Phone:806-785-2045
Mailing Address - Fax:806-785-0872
Practice Address - Street 1:6401 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5740
Practice Address - Country:US
Practice Address - Phone:806-771-6868
Practice Address - Fax:806-771-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138166713Medicaid
B23872Medicare UPIN
TX138166713Medicaid