Provider Demographics
NPI:1053962712
Name:WILLIAMS, RICK JAY
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:JAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4723 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9569
Mailing Address - Country:US
Mailing Address - Phone:208-466-1290
Mailing Address - Fax:
Practice Address - Street 1:4723 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9569
Practice Address - Country:US
Practice Address - Phone:208-466-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies