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General NPI Number Information
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NPI Number | 1396186508
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Entity Type | Organization
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Legal Business Name | MEDICAL CARE SLEEP LAB
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 1402 WAYNE MEMORIAL DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-2235
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Country | US
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Telephone | 919-725-3311
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Fax | 919-735-2999
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Provider Business Mailing Address
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Address Line | 1402 WAYNE MEMORIAL DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-2235
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Country | US
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Telephone | 919-725-3311
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Fax | 919-735-2999
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILSON EGBE TABE
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Credential | MD
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Telephone | 919-725-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200101288
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License Number State | NC
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