Provider Demographics
NPI:1740425008
Name:WILMED IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:WILMED IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
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 1:1711 MEDICAL PARK DR W
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2788
Mailing Address - Country:US
Mailing Address - Phone:252-399-8138
Mailing Address - Fax:252-399-8778
Practice Address - Street 1:1711 MEDICAL PARK DR W
Practice Address - Street 2:SUITE B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2788
Practice Address - Country:US
Practice Address - Phone:252-399-7430
Practice Address - Fax:252-243-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)