Active NPI
Dickie Eugene Willard
- Contractor
- Inverness, FL
National Provider Identifier
1316113111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- Practice address
- 3040 E Queens CT
Inverness, FL 34453-0413 - Phone
- (352) 637-1608
- Fax
- (352) 637-1608
- NPI assigned
- May 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Primary |
Addresses
Primary practice location
3040 E Queens CT
Inverness, FL 34453-0413
Mailing address
3040 E Queens CT
Inverness, FL 34453-0413
Phone (352) 637-1608
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 230022200 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240358400000",
"number": "1316113111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3040 E QUEENS CT",
"city": "INVERNESS",
"state": "FL",
"postal_code": "344530413",
"telephone_number": "352-637-1608",
"fax_number": "352-637-1608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3040 E QUEENS CT",
"city": "INVERNESS",
"state": "FL",
"postal_code": "344530413",
"telephone_number": "352-637-1608",
"fax_number": "352-637-1608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLARD",
"first_name": "DICKIE",
"middle_name": "EUGENE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-01",
"last_updated": "2009-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "230022200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Inverness, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.