Provider Demographics
NPI:1275581654
Name:DR JAMES E WILSON SC
Entity Type:Organization
Organization Name:DR JAMES E WILSON SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-873-7546
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0378
Mailing Address - Country:US
Mailing Address - Phone:773-433-3838
Mailing Address - Fax:708-301-0600
Practice Address - Street 1:101 EAST 75TH STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1469
Practice Address - Country:US
Practice Address - Phone:887-873-7546
Practice Address - Fax:877-893-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 208VP0014X
IL036078688208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208142Medicare ID - Type Unspecified
E42147Medicare UPIN