Provider Demographics
NPI:1679521983
Name:WILSON IMMEDIATE CARE, PA
Entity Type:Organization
Organization Name:WILSON IMMEDIATE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KRABILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-237-2891
Mailing Address - Street 1:1725 S. TARBORO STREET
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-237-2891
Mailing Address - Fax:252-237-0115
Practice Address - Street 1:1725 S. TARBORO STREET
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-237-2891
Practice Address - Fax:252-237-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25535207Q00000X
NC94-00464207Q00000X
NC90900464207R00000X
261QUO200X261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC86719Medicare UPIN
NCF87896Medicare UPIN
NCC88628Medicare UPIN
NC2313438Medicare ID - Type Unspecified