Provider Demographics
NPI:1437120177
Name:WILMED MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:WILMED MEDICAL CENTER INC.
Other - Org Name:HOME CARE OF WILSON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT & CHIEF FINANCIAL OF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:D
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-399-8230
Mailing Address - Street 1:1705 TARBORO STREET SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3428
Mailing Address - Country:US
Mailing Address - Phone:252-399-8924
Mailing Address - Fax:252-399-7369
Practice Address - Street 1:1705 SOUTH TARBORO STREET
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-399-7431
Practice Address - Fax:252-399-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1161251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600375Medicaid
NC3408640Medicaid
NC0416ROtherBLUE CROSS AND BLUE SHIEL