Healthcare Provider Details

I. General information

NPI: 1104107341
Provider Name (Legal Business Name): THE WILSON GROUP BILLING CLAIMS AND HEALTHCARE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 CORTEZ BLVD
BROOKSVILLE FL
34613-2630
US

IV. Provider business mailing address

514 GREENTREE CIR
LAKE WALES FL
33853-3309
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-5792
  • Fax:
Mailing address:
  • Phone: 863-676-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. SARA ELQREISH
Title or Position: MANAGER
Credential:
Phone: 863-676-4248