Provider Demographics
NPI:1538467501
Name:WILSON MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WILSON MEDICAL CENTER, INC.
Other - Org Name:HOME CARE OF WILSON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
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 1:1705 TARBORO ST SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3428
Mailing Address - Country:US
Mailing Address - Phone:252-399-7431
Mailing Address - Fax:252-399-6369
Practice Address - Street 1:1705 TARBORO ST SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3428
Practice Address - Country:US
Practice Address - Phone:252-399-7431
Practice Address - Fax:252-399-6369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1161251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602116Medicaid
NC3418910Medicaid