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General NPI Number Information
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NPI Number | 1932401411
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Entity Type | Organization
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Legal Business Name | WILMINGTON PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 610 W MAIN ST
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City | WILMINGTON
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State | OH
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Zip | 45177-2125
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Country | US
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Telephone | 937-382-5438
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Fax | 937-382-5260
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Provider Business Mailing Address
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Address Line | 610 W MAIN ST
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City | WILMINGTON
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State | OH
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Zip | 45177-2125
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Country | US
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Telephone | 937-283-9845
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Fax | 937-283-9839
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Authorized Official
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Title or Position | SECRETARY
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Name | KATHY J TEAGUE
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Credential |
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Telephone | 615-920-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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