Provider Demographics
NPI:1588845598
Name:WILNER MEDICAL ASSOICATES PA
Entity Type:Organization
Organization Name:WILNER MEDICAL ASSOICATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-665-1280
Mailing Address - Street 1:251 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4415
Mailing Address - Country:US
Mailing Address - Phone:843-665-1280
Mailing Address - Fax:843-679-4246
Practice Address - Street 1:251 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4415
Practice Address - Country:US
Practice Address - Phone:843-665-1280
Practice Address - Fax:843-679-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19078207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC190787Medicaid
E39651Medicare UPIN
SC190787Medicaid