Physician Compare National (NPI:1184633521)

HEALTHCARE PROVIDER: WILSON L DAVIS MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1184633521
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6901717131
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20181210001042
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAVIS
	Individual professional last name
Provider First Name	WILSON
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4284537457
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	13
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	610 E 24TH ST
	Group Practice or individual's line 1 address
City	TISHOMINGO
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	734603245
	Group Practice or individual's zip code (9 digits when available)
Phone Number	58037123433327
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	370047
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY HOSPITAL ARDMORE, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	371304
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MERCY HOSPITAL TISHOMINGO INC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	370014
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ALLIANCEHEALTH DURANT
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y