Basic Information
| Provider Information | |||||||||
| NPI: | 1982633871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM O. KEARSE MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16304 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794906304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067852045 | ||||||||
| FaxNumber: | 8067850872 | ||||||||
| Practice Location | |||||||||
| Address1: | 6401 INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794135740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067716868 | ||||||||
| FaxNumber: | 8067717444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 03/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | HINOJOSA | ||||||||
| AuthorizedOfficialFirstName: | YVETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 8067610333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | J9933 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 138166713 | 05 | TX | MEDICAID |