Provider Demographics
NPI:1184797235
Name:WILSON FAMILY PRACTICE CTR
Entity type:Organization
Organization Name:WILSON FAMILY PRACTICE CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:SIGMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-291-2215
Mailing Address - Street 1:4008 NC HWY. 42 W.
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-7774
Mailing Address - Country:US
Mailing Address - Phone:252-291-2215
Mailing Address - Fax:252-237-2281
Practice Address - Street 1:4008 NC HWY. 42 W.
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-7774
Practice Address - Country:US
Practice Address - Phone:252-291-2215
Practice Address - Fax:252-237-2281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON FAMILY PRACTICE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-16
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890296AMedicaid
2309651AMedicare ID - Type Unspecified
NCD92847Medicare UPIN
D92847Medicare UPIN
NC890296AMedicaid