Healthcare Provider Details

I. General information

NPI: 1326251661
Provider Name (Legal Business Name): WILSON RADIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S GRACE ST
ROCKY MOUNT NC
27804-5602
US

IV. Provider business mailing address

PO BOX 2385
ROCKY MOUNT NC
27802-2385
US

V. Phone/Fax

Practice location:
  • Phone: 252-977-0125
  • Fax: 252-977-7779
Mailing address:
  • Phone: 252-977-0125
  • Fax: 252-977-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number200100345
License Number StateNC

VIII. Authorized Official

Name: MRS. SHIRLEY E CREECH
Title or Position: PHYSICIAN BILLING MANAGER
Credential: CCSP
Phone: 252-977-0125