=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801071402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORACLE PRIME,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2008
-----------------------------------------------------
Last Update Date | 03/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E MARKET ST SUITE 2
-----------------------------------------------------
City | JEFFERSONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47130-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-280-0160
-----------------------------------------------------
Fax | 812-280-0160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 E MARKET ST SUITE 2
-----------------------------------------------------
City | JEFFERSONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47130-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-280-0160
-----------------------------------------------------
Fax | 812-280-0160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. DENNIS R WILLIAMS
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 812-280-0160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 07000624A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------