=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225276140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLER ORTHOPEDIC ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2009
-----------------------------------------------------
Last Update Date | 01/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 E MAIN ST
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520-3491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-443-7173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 E MAIN ST
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520-3491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-443-7173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN / OWNER
-----------------------------------------------------
Name | DR. WILLIAM DOUGLAS HILLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 800-443-7173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 8001A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------