Provider Demographics
NPI:1871751560
Name:NANCY S. WILLIAMS, MD SC
Entity type:Organization
Organization Name:NANCY S. WILLIAMS, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-562-8735
Mailing Address - Street 1:1181 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-2416
Mailing Address - Country:US
Mailing Address - Phone:815-562-8735
Mailing Address - Fax:815-562-2934
Practice Address - Street 1:1181 N 8TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-2416
Practice Address - Country:US
Practice Address - Phone:815-562-8735
Practice Address - Fax:815-562-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36057715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057715Medicaid
IL036057715Medicaid
ILD14378Medicare UPIN