MEDICARE: GENE WILLIAMSON COO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	1681-0-ASO	IN

General Provider Information

NPI Number	:	1144612482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE WILLIAMSON COO

Provider Business Mailing Address
First Line	:	2105 N. MERIDIAN ST.
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

Provider Business Practice Location Address
First Line	:	2105 N. MERIDIAN ST.
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	02/24/2015

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