Provider Demographics
NPI:1962538447
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:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
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 1:11180 FINCH AVENUE
Mailing Address - Street 2:P.O. BOX 879
Mailing Address - City:MIDDLESEX
Mailing Address - State:NC
Mailing Address - Zip Code:27557-0879
Mailing Address - Country:US
Mailing Address - Phone:252-235-2298
Mailing Address - Fax:252-399-8829
Practice Address - Street 1:11180 FINCH AVENUE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NC
Practice Address - Zip Code:27557
Practice Address - Country:US
Practice Address - Phone:252-235-2298
Practice Address - Fax:252-399-8829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0156LOtherNC BC PROVIDER NO.
NC7901436Medicaid
NC7901436Medicaid