J. TODD WILLIS, MD CLINIC (NPI# 1053788240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053788240 |
| Entity Type | Organization |
| Organization Name | J. TODD WILLIS, MD CLINIC |
| Practice Address |
1003 Holland Avenue Suite 104 Philadelphia MS 39350-2180 |
| Mailing Address |
1003 Holland Ave Suite 104 Philadelphia MS 39350-2180 |
| Practice Telephone | 6016560010 |
| Practice Fax Number | 6016560313 |
| Mailing Telephone | 6016560010 |
| Mailing Fax Number | 6016560313 |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |
| Authorized Official Name | CHERYL LEANN SAVELL (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 6016631285 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 12556 | MS | Allopathic & Osteopathic Physicians |
| Street Address |
1003 HOLLAND AVENUE SUITE 104 |
| City | PHILADELPHIA |
| State | MS |
| Zip Code | 39350-2180 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548817133 | Airpark Family Dentistry | Dentist | 1060 Holland Avenue, Philadelphia, MS 39350 | 2019-08-20 |
| 1396303962 | Medical Foundation Inc | Obstetrics & Gynecology | Rush Medical Group / Philadelphia, 1106 Central Drive, Ste 3, Philadelphia, MS 39350 | 2019-05-30 |
| 1144759580 | Mapp Home Care Services | In Home Supportive Care | 41 Eastover Dr, Philadelphia, MS 39350 | 2017-06-08 |
| 1710411707 | Rcg Mississippi, Inc. | Clinic/Center | 1100 Central Drive, Philadelphia, MS 39350 | 2017-04-17 |
| 1114339405 | Bernard Oneal | Adult Companion | 10090 Rd 0022, None, Philadelphia, MS 39350 | 2014-05-21 |
| 1417213323 | Region Ten Commision On Mental Health | Clinic/Center | 1011 Posey Avenue, Philadelphia, MS 39350 | 2012-04-04 |
| 1851427132 | Performance Therapy LLC | Physical Therapist | Performance Therapy, LLC, 921 W Beacon Street, Philadelphia, MS 39350 | 2007-02-23 |
| 1922161900 | Ernest Barton Cross | Audiologist | 1120 East Main Street, Suite 4, Philadelphia, MS 39350 | 2006-12-19 |
| 1649348129 | Augustus P Soriano | Family Medicine | 517 Center Avenue, Philadelphia, MS 39350 | 2006-12-01 |
| 1982777983 | Bill G Molpus | Dentist | 247 Byrd Ave, Philadelphia, MS 39350 | 2006-11-16 |
| Find all providers in zip 39350 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1790135358 | Jeffrey Anthony Gazzara Jr. | General Practice | 621, 1515 Market Street, Suite 1200, Philadelphia, PA 19102-1921 | 2016-06-14 |
| 1225411655 | Brian Michael Lauer | General Practice | 609 E Passyunk Ave Apt 2, Philadelphia, PA 19147-1530 | 2015-07-02 |
| 1003294588 | Health Hero Pa LLC | General Practice | 217 Dickinson St, Philadelphia, PA 19147-6003 | 2015-05-15 |
| 1225447592 | Miriam Medical Clinics Inc | General Practice | 2847 N 26th St, Philadelphia, PA 19132-2508 | 2014-08-11 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 39350 |
Please comment or provide details below to improve the information on J. TODD WILLIS, MD CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.