=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235633389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM ALAN BISHOP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2018
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 GOOD SAMARITAN WAY STE 235
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62864-2476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-899-3980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 FREEDOM LN
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43566-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-277-0576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 01090400A
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------