MEDICARE: WILLIAMS CLINIC, LTD

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	207R00000X	Internal Medicine Physician	R9968	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376722108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMS CLINIC, LTD

Provider Business Mailing Address
First Line	:	3409 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1127
Country	:	US
Telephone Number	:	314-261-4834
Fax Number	:	314-383-3970

Provider Business Practice Location Address
First Line	:	3409 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1127
Country	:	US
Telephone Number	:	314-261-4834
Fax Number	:	314-383-3970

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ROY JEROME WILLIAMS JR.
Credential	:	M.D.
Telephone Number	:	314-261-4834

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	09/11/2011

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3409 UNION BLVD
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1770505059 — AUNITA MARIE HILL-JONES M.D.
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1326125782 — DR. KENNETH SENIOR POWELL II D.D.S.
Practice Location Address:

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