William Kimball Mellor, M.D.
Individual provider Active NPI Family Medicine Physician · Colfax, WA
NPI 1144200460 · NPPES record last updated Oct 14, 2008
Key facts
- NPI
- 1144200460
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD00024848 (WA)
- Practice address
- 1210 W Fairview St
Colfax, WA 99111-9552 - Phone
- (509) 397-4717
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100218000281 | WA | Practitioner - Family Practice | 8123162880 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Public Hospital District No 3 of Whitman County | Current |
Accepting new patients |
Locations
1210 W Fairview St
Colfax, WA 99111
Phone (509) 397-4717
1200 W Fairview St
Colfax, WA 99111
Phone (509) 397-3435
Interoperability endpoints
- mail.wht@direct.inhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00024848 | WA | Yes |
Addresses
Primary practice location
1210 W Fairview St
Colfax, WA 99111-9552
Mailing address
1210 W Fairview St
Colfax, WA 99111-9552
Phone (509) 397-4717
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1044718 | Medicaid | WA |
Other providers in Colfax, WA
- Bob M McGinity
- Jennifer E McKinney
- Tom H McKinney
- Maria Grace McWade
- Matthew Mellor
- Zachary Milcawich
- Ryann Evelyn Miller
- Kristin Lynn Morgan
- Robert Bruce Morgan
- Brooke Morse
All providers in Colfax, WA · Family Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.