Active NPI
Bradley Willis
- Veterinarian
- Athens, IL
National Provider Identifier
1922419605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Veterinarian
- License
- 090008708
- Practice address
- 105 N Main St
Athens, IL 62613-8901 - Phone
- (217) 636-7388
- NPI assigned
- May 15, 2014
- 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 |
|---|---|---|---|---|
| Veterinarian | 174M00000X | 090008708 | IL | Primary |
Addresses
Primary practice location
105 N Main St
Athens, IL 62613-8901
Mailing address
PO Box 65
Athens, IL 62613-0065
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 090008708 | IL | MD | Veterinarian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400112000000",
"number": "1922419605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 65",
"city": "ATHENS",
"state": "IL",
"postal_code": "626130065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 N MAIN ST",
"city": "ATHENS",
"state": "IL",
"postal_code": "626138901",
"telephone_number": "217-636-7388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "BRADLEY",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-15",
"last_updated": "2014-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "174M00000X",
"taxonomy_group": "",
"desc": "Veterinarian",
"state": "IL",
"license": "090008708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.