Provider Demographics
NPI:1366415630
Name:WILSON MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:WILSON MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT & CHIEF FINANCIAL OF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:D
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-399-8138
Mailing Address - Street 1:1705 TARBORO STREET, SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3428
Mailing Address - Country:US
Mailing Address - Phone:252-399-8924
Mailing Address - Fax:252-399-7369
Practice Address - Street 1:1705 TARBORO STREET ,SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3428
Practice Address - Country:US
Practice Address - Phone:252-399-8924
Practice Address - Fax:252-399-7369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS0408251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401532Medicaid
NC0022FOtherBCBS PROVIDER #
NC0738150OtherCIGNA PROVIDER #
NC3401532Medicaid