Healthcare Provider Details

I. General information

NPI: 1962538447
Provider Name (Legal Business Name): WILSON MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 FINCH AVENUE
MIDDLESEX NC
27557
US

IV. Provider business mailing address

11180 FINCH AVENUE P.O. BOX 879
MIDDLESEX NC
27557-0879
US

V. Phone/Fax

Practice location:
  • Phone: 252-235-2298
  • Fax: 252-399-8829
Mailing address:
  • Phone: 252-235-2298
  • Fax: 252-399-8829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD E. HUDSON
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 252-399-8139