Provider Demographics
NPI:1467524363
Name:WILTEX
Entity Type:Organization
Organization Name:WILTEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:STOVALL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-961-3734
Mailing Address - Street 1:1012 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3606
Mailing Address - Country:US
Mailing Address - Phone:757-961-3734
Mailing Address - Fax:757-627-5333
Practice Address - Street 1:1012 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3606
Practice Address - Country:US
Practice Address - Phone:757-961-3734
Practice Address - Fax:757-627-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare