Basic Information
| Provider Information | |||||||||
| NPI: | 1790778801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMONS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 HERMAN AVENUE EXT | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288038100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286762960 | ||||||||
| FaxNumber: | 9498621960 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 BELLINGER ST | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547035222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158383635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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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 | 2084P0800X | 0000-18058 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 69540 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 8976313 | 05 | NC | MEDICAID | 76313 | 01 | NC | BCBS | OTHER | P00341710 | 01 | RAILROAD MEDICARE B | OTHER |