Charles R Williams MD PA

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

CHARLES R WILLIAMS MD PA

Doing business as

East Texas Orthopaedic Clinic

Practice address

804 Medical Circle
Suite H
Longview, TX 75605

Phone

(903) 236-3385

Fax

(903) 236-4766

NPI assigned

Apr 2, 2012

Last updated

May 1, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Karen R Williams

Title

Business Manager

Phone

(903) 236-3385

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• East Texas Orthopaedic Clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1295091486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 MEDICAL CIRCLE DR. SUITE H",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-236-3385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 MEDICAL CIRCLE",
            "address_2": "SUITE H",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-236-3385",
            "fax_number": "903-236-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES R WILLIAMS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-02",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "903-236-3385",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "089595501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Texas Orthopaedic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sports Medicine (Orthopaedic Surgery) Physician in Longview, TX
• Providers in Longview, TX by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.