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Organization

ICC MEDICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROGER WILLIAMS MD (OWNER)
(270) 834-8892
Entity
Organization

Contact information

Practice address
405 S L ROGERS WELLS BLVD, GLASGOW, KY 42141-1725
(270) 834-8892
(270) 834-8899
Mailing address
405 S L ROGERS WELLS BLVD, GLASGOW, KY 42141-1725
(270) 834-8892
(270) 834-8899

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4074P
KY

Other

Enumeration date
10/01/2007
Last updated
10/01/2007
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