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NPI Code Detail

MEDICARE: MR. WILLIAM HENRY NIEMEYER III P.A.-C

MEDICARE: MR. WILLIAM HENRY NIEMEYER III P.A.-C
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
1363A00000XPhysician AssistantPA01134RI
2363A00000XPhysician Assistant004173CT
3363A00000XPhysician Assistant085-001528IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1004173OTHERCTCT LIC

General Provider Information

NPI Number : 1861435679
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM HENRY NIEMEYER III P.A.-C
Provider Business Mailing Address
First Line : 1832 ASHLEY DRIVE
Second Line :
City : CHARLESTON
State : IL
Zip : 61920
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 385 W MAIN ST
Second Line :
City : AVON
State : CT
Zip : 06001-4357
Country : US
Telephone Number : 860-777-1280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 09/21/2020

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