Provider Demographics
NPI:1639592116
Name:WILSON MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WILSON MEDICAL CENTER, INC.
Other - Org Name:PULMONARY ASSOCIATES OF WILSON
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 200
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3481
Mailing Address - Country:US
Mailing Address - Phone:252-399-8040
Mailing Address - Fax:252-399-8778
Practice Address - Street 1:1700 TARBORO ST W
Practice Address - Street 2:SUITE 200
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3481
Practice Address - Country:US
Practice Address - Phone:252-399-8040
Practice Address - Fax:252-399-8778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty