Provider Demographics
NPI:1275123044
Name:WILSON MEDICAL PRACTICE LLC
Entity Type:Organization
Organization Name:WILSON MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:614-406-6381
Mailing Address - Street 1:3433 AGLER RD STE 2100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3389
Mailing Address - Country:US
Mailing Address - Phone:614-406-6381
Mailing Address - Fax:614-505-2691
Practice Address - Street 1:3433 AGLER RD STE 2100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3389
Practice Address - Country:US
Practice Address - Phone:614-406-6381
Practice Address - Fax:614-505-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty