Healthcare Provider Details

I. General information

NPI: 1215411327
Provider Name (Legal Business Name): WILLIAMS MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 04/23/2023
Certification Date: 04/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13310 GILLETTE ST APT 16105
OVERLAND PARK KS
66213-4975
US

IV. Provider business mailing address

13310 GILLETTE ST APT 16105
OVERLAND PARK KS
66213-4975
US

V. Phone/Fax

Practice location:
  • Phone: 913-368-3670
  • Fax:
Mailing address:
  • Phone: 913-368-3670
  • Fax: 314-228-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA BOSTON
Title or Position: PHYSICIAN
Credential: MD
Phone: 913-368-3760