MEDICARE: ROGER TODD WILLIAMS MD PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	37488	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DB3991	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0000000299382	OTHER	KY	BC/BS PIN

General Provider Information

NPI Number	:	1538118245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER TODD WILLIAMS MD PSC

Provider Business Mailing Address
First Line	:	400 N DIXIE HWY
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-9512
Country	:	US
Telephone Number	:	270-773-3737
Fax Number	:	270-773-3738

Provider Business Practice Location Address
First Line	:	400 N DIXIE HWY
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-9512
Country	:	US
Telephone Number	:	270-773-3737
Fax Number	:	270-773-3738

Authorized Official
Title or Position	:	OWNER/ PHYSICIAN
Name	:	DR. ROGER TODD WILLIAMS
Credential	:	M.D.
Telephone Number	:	270-773-3737

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/18/2008

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