Provider Demographics
NPI:1326251661
Name:WILSON RADIOLOGY INC
Entity Type:Organization
Organization Name:WILSON RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:CCSP
Authorized Official - Phone:252-977-0125
Mailing Address - Street 1:PO BOX 2385
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2385
Mailing Address - Country:US
Mailing Address - Phone:252-977-0125
Mailing Address - Fax:252-977-7779
Practice Address - Street 1:123 S GRACE ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5602
Practice Address - Country:US
Practice Address - Phone:252-977-0125
Practice Address - Fax:252-977-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100345247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902947Medicaid
NC204262Medicare PIN
NCG52729Medicare UPIN
NC8902947Medicaid