Provider Demographics
NPI:1457784985
Name:W. JOHN NICHOLAS, MD, PC
Entity Type:Organization
Organization Name:W. JOHN NICHOLAS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-347-6400
Mailing Address - Street 1:PO BOX 4336
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-4336
Mailing Address - Country:US
Mailing Address - Phone:417-347-6400
Mailing Address - Fax:417-347-6404
Practice Address - Street 1:3202 MCINTOSH CIR
Practice Address - Street 2:STE LL03
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3646
Practice Address - Country:US
Practice Address - Phone:417-347-6400
Practice Address - Fax:417-347-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty