Provider Demographics
NPI:1881898922
Name:WILLIAMS FAMILY PRACTICE, P A
Entity type:Organization
Organization Name:WILLIAMS FAMILY PRACTICE, P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:BALMORE
Authorized Official - Middle Name:WILLOUGHBY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-592-2656
Mailing Address - Street 1:309 E CROCKETT ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-3810
Mailing Address - Country:US
Mailing Address - Phone:281-592-2656
Mailing Address - Fax:281-592-9723
Practice Address - Street 1:309 E CROCKETT ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-3810
Practice Address - Country:US
Practice Address - Phone:281-592-2656
Practice Address - Fax:281-592-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041GWOtherBCBS GROUP
TX1932103629OtherNPI
TX144323602Medicaid
TX144323601Medicaid
TX8B9860OtherBCBS PROVIDER
TX8L24253Medicare Oscar/Certification
TX1932103629OtherNPI
TX0041GWOtherBCBS GROUP
TX144323602Medicaid
TX00Z967Medicare PIN