Healthcare Provider Details

I. General information

NPI: 1679521983
Provider Name (Legal Business Name): WILSON IMMEDIATE CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 S. TARBORO STREET
WILSON NC
27893
US

IV. Provider business mailing address

1725 S. TARBORO STREET
WILSON NC
27893
US

V. Phone/Fax

Practice location:
  • Phone: 252-237-2891
  • Fax: 252-237-0115
Mailing address:
  • Phone: 252-237-2891
  • Fax: 252-237-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25535
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-00464
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number90900464
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number261QUO200X
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE DAVID KRABILL
Title or Position: PRESIDENT
Credential: MD
Phone: 252-237-2891