Provider Demographics
NPI:1033438718
Name:WILSON MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WILSON MEDICAL CENTER, INC.
Other - Org Name:WILSON NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-399-8139
Mailing Address - Street 1:1700 TARBORO ST W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3481
Mailing Address - Country:US
Mailing Address - Phone:252-399-5306
Mailing Address - Fax:252-399-5307
Practice Address - Street 1:1700 TARBORO ST W
Practice Address - Street 2:SUITE 200
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3481
Practice Address - Country:US
Practice Address - Phone:252-399-5306
Practice Address - Fax:252-399-5307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-20
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2341718Medicare PIN