Provider Demographics
NPI:1114150174
Name:WILKES ENTERPRISES HEALING PLACE MEDICAL CENTER
Entity Type:Organization
Organization Name:WILKES ENTERPRISES HEALING PLACE MEDICAL CENTER
Other - Org Name:HEALING PLACE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-658-2036
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0887
Mailing Address - Country:US
Mailing Address - Phone:225-658-2036
Mailing Address - Fax:225-658-9788
Practice Address - Street 1:6110 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4033
Practice Address - Country:US
Practice Address - Phone:225-658-2036
Practice Address - Fax:225-658-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty