Basic Information
| Provider Information | |||||||||
| NPI: | 1033205315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 PRAIRIE ST | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619441433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172653146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 721 E COURT ST | ||||||||
| Address2: | PARIS COMMUNITY HOSPITAL | ||||||||
| City: | PARIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174654141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R858455 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 209.007081 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 07359093 | 05 | MS | MEDICAID |