Provider Demographics
NPI:1801357587
Name:WILLIAMS, BOOKER T
Entity type:Individual
Prefix:
First Name:BOOKER
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11922 ARMITAGE DR
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1216
Mailing Address - Country:US
Mailing Address - Phone:816-765-1652
Mailing Address - Fax:816-394-0300
Practice Address - Street 1:11922 ARMITAGE DR
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1216
Practice Address - Country:US
Practice Address - Phone:816-765-1652
Practice Address - Fax:816-394-0300
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO682343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)