Timothy R Williams, DO
Individual provider Active NPI Emergency Medicine Physician · Lawrenceville, IL
NPI 1194723247 · NPPES record last updated Mar 23, 2016
Key facts
- NPI
- 1194723247
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 02001015A (IN)
- Practice address
- 2200 State St
Lawrenceville, IL 62439-1852 - Phone
- (618) 943-7242
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20050209000117 | IN | Practitioner - Emergency Medicine |
9830094978 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.120252 | IL | MD | Anesthesiology Physician |
| 02001015AB | IN | MD | Emergency Medical Services (Emergency Medicine) Physician |
| 4034 | OK | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid West Hospital Physicians, PLLC | Current |
Accepting new patients | |
| Great Lakes Emergency Physicians, PLLC | Emergency Medicine | Current |
Accepting new patients |
| Anesthesia Associates of Jefferson County | Anesthesiology | Past | Accepting new patients |
| Providence Physician Group Inc | Anesthesiology | Past | Accepting new patients |
| Lawrence County Memorial Hospital | Past | Accepting new patients | |
| Deaconess Memorial Medical Center Inc | Past | Accepting new patients | |
| Northeast Indiana Anesthesiology, PC | Anesthesiology | Past | Accepting new patients |
Locations
1808 Sherman Dr
Princeton, IN 47670
Phone (812) 385-3401
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 02001015AB | IN | |
| Anesthesiology Physician | 207L00000X | 036.120252 | IL | |
| Emergency Medicine Physician | 207P00000X | 02001015A | IN | Yes |
Addresses
Primary practice location
2200 State St
Lawrenceville, IL 62439-1852
Mailing address
2200 West State St.
Lawrenceville, IL 62439
Phone (618) 943-7242
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 245815311 | Medicaid | MO |
Other providers in Lawrenceville, IL
- Phyllis J Wells
- Lauren E Welton
- West Grove, Inc
- Isabella Diane Weston
- Kathleen E White
- Christy M Wimberly
- Rachel Ann Winters
- Caina Wisdom
- Ashley Wiseman
- Sherry Lynn Wood
All providers in Lawrenceville, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2016. 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.