Provider Demographics
NPI:1508097478
Name:WILSON MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WILSON MEDICAL CENTER, INC.
Other - Org Name:WILSON ENT & SINUS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-399-8139
Mailing Address - Street 1:1700 TARBORO ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3481
Mailing Address - Country:US
Mailing Address - Phone:252-399-5300
Mailing Address - Fax:252-399-5301
Practice Address - Street 1:1700 TARBORO ST W
Practice Address - Street 2:SUITE 100
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3481
Practice Address - Country:US
Practice Address - Phone:252-399-5300
Practice Address - Fax:252-399-5301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILMED HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-27
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicare PIN