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General NPI Number Information
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NPI Number | 1215713854
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Entity Type | Organization
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Legal Business Name | THVC SERVICES OF KS PA
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 801 E DOUGLAS AVE FL 2
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City | WICHITA
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State | KS
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Zip | 67202-3548
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Country | US
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Telephone | 865-693-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 265 BROOKVIEW CENTRE WAY STE 203
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City | KNOXVILLE
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State | TN
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Zip | 37919-4052
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Country | US
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Telephone | 865-693-1000
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LANCE DEAN WILLIAMS
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Credential | MD
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Telephone | 865-693-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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