Basic Information
| Provider Information | |||||||||
| NPI: | 1639592116 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WILSON MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PULMONARY ASSOCIATES OF WILSON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 TARBORO ST W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278933481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523998040 | ||||||||
| FaxNumber: | 2523998778 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 TARBORO ST W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278933481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523998040 | ||||||||
| FaxNumber: | 2523998778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2014 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | HUDSON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 2523998139 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WILSON MEDICAL CENTER, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0012X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.