Provider Demographics
NPI:1114079316
Name:WILKENS MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:WILKENS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-784-3667
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0028
Mailing Address - Country:US
Mailing Address - Phone:423-784-7269
Mailing Address - Fax:423-784-3708
Practice Address - Street 1:131 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-4404
Practice Address - Country:US
Practice Address - Phone:423-784-7269
Practice Address - Fax:423-784-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65938771Medicaid
TN3717798Medicaid
TN3717798Medicare ID - Type Unspecified
KY0906101Medicare ID - Type Unspecified