Provider Demographics
NPI:1801986211
Name:WILSONS INC
Entity type:Organization
Organization Name:WILSONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ONEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-774-4326
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:258 MAIN ST
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01302-1520
Mailing Address - Country:US
Mailing Address - Phone:413-774-4326
Mailing Address - Fax:413-774-2878
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3202
Practice Address - Country:US
Practice Address - Phone:413-774-4326
Practice Address - Fax:413-774-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA195354OtherBLUE CROSS BLUE SHIELD
MA195354OtherBLUE CROSS BLUE SHIELD