Healthcare Provider Details

I. General information

NPI: 1578113817
Provider Name (Legal Business Name): THE CARTER WILLIAMS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 OAKBROOK CT
SAUK VILLAGE IL
60411-5289
US

IV. Provider business mailing address

1806 OAKBROOK CT
SAUK VILLAGE IL
60411-5289
US

V. Phone/Fax

Practice location:
  • Phone: 833-422-7837
  • Fax: 219-501-4546
Mailing address:
  • Phone: 833-422-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DONALD WILLIAMS
Title or Position: AGENCY MANAGER
Credential:
Phone: 833-422-7837