Provider Demographics
NPI:1396186508
Name:MEDICAL CARE SLEEP LAB
Entity Type:Organization
Organization Name:MEDICAL CARE SLEEP LAB
Other - Org Name:MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:EGBE
Authorized Official - Last Name:TABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-725-3311
Mailing Address - Street 1:1402 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2235
Mailing Address - Country:US
Mailing Address - Phone:919-725-3311
Mailing Address - Fax:919-735-2999
Practice Address - Street 1:1402 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2235
Practice Address - Country:US
Practice Address - Phone:919-725-3311
Practice Address - Fax:919-735-2999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CARE,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917316Medicaid
H50457Medicare UPIN