MEDICARE: COURTNEY R WILLIAMS

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	343900000X	Non-emergency Medical Transport (VAN)	20380286	TX
2	347C00000X	Private Vehicle	20380286	TX

General Provider Information

NPI Number	:	1548640022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY R WILLIAMS

Provider Business Mailing Address
First Line	:	PO BOX 1863
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77347-1863
Country	:	US
Telephone Number	:	713-705-5916
Fax Number	:

Provider Business Practice Location Address
First Line	:	12420 TYLER SPRINGS LN
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-2995
Country	:	US
Telephone Number	:	713-705-5916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	06/01/2015

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Directions to “ COURTNEY R WILLIAMS ” Practice Location

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