MEDICARE: WILMED MEDICAL CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HC1161	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0416R	OTHER	NC	BLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number	:	1437120177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILMED MEDICAL CENTER INC.

Provider Business Mailing Address
First Line	:	1705 TARBORO STREET SW
Second Line	:	SUITE B
City	:	WILSON
State	:	NC
Zip	:	27893-3428
Country	:	US
Telephone Number	:	252-399-8924
Fax Number	:	252-399-7369

Provider Business Practice Location Address
First Line	:	1705 SOUTH TARBORO STREET
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893
Country	:	US
Telephone Number	:	252-399-7431
Fax Number	:	252-399-7369

Authorized Official
Title or Position	:	VICE-PRESIDENT & CHIEF FINANCIAL OF
Name	:	MR. DAMON D. SORENSEN
Credential	:
Telephone Number	:	252-399-8230

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	10/08/2010

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