Provider Demographics
NPI:1235422510
Name:WILSON MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WILSON MEDICAL CENTER, INC.
Other - Org Name:WILSON GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
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 1:2605 FOREST HILLS RD SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4448
Mailing Address - Country:US
Mailing Address - Phone:252-243-7977
Mailing Address - Fax:
Practice Address - Street 1:2605 FOREST HILLS RD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4448
Practice Address - Country:US
Practice Address - Phone:252-243-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2341718Medicare PIN