Provider Demographics
NPI:1386827251
Name:MOORE COUNTY ANESTHESIA ASSOCIATES DR JOSEPH B WICKER
Entity Type:Organization
Organization Name:MOORE COUNTY ANESTHESIA ASSOCIATES DR JOSEPH B WICKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BEAMAN
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-295-2920
Mailing Address - Street 1:45 CANTER LN
Mailing Address - Street 2:PO BOX 5249
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8666
Mailing Address - Country:US
Mailing Address - Phone:910-295-2920
Mailing Address - Fax:910-295-4640
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-295-2920
Practice Address - Fax:910-295-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26166207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC050085497OtherRAILROAD MEDICARE
NC8987269Medicaid
SCQ26166Medicaid
NC2322696OtherMEDICARE GROUP NUMBER
NC2322696OtherMEDICARE GROUP NUMBER
NC8987269Medicaid