Provider Demographics
NPI:1154495885
Name:WILSON'S ABBEY MEDI CAB
Entity Type:Organization
Organization Name:WILSON'S ABBEY MEDI CAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-594-4716
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-0291
Mailing Address - Country:US
Mailing Address - Phone:559-594-4716
Mailing Address - Fax:559-592-4953
Practice Address - Street 1:160 S E ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1731
Practice Address - Country:US
Practice Address - Phone:559-594-4716
Practice Address - Fax:559-592-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01114FMedicaid