Provider Demographics
NPI:1639365562
Name:WILMINGTON HEALTH PLLC
Entity Type:Organization
Organization Name:WILMINGTON HEALTH PLLC
Other - Org Name:CHILDRENS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-341-3384
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-763-2072
Mailing Address - Fax:910-763-1586
Practice Address - Street 1:2421 SILVER STREAM LANE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-763-2072
Practice Address - Fax:910-763-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2023-03-15
Deactivation Date:2023-02-03
Deactivation Code:
Reactivation Date:2023-03-15
Provider Licenses
StateLicense IDTaxonomies
NCNC73991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89022ILMedicaid
NC89022ILMedicaid