MEDICARE: WILSON CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	208000000X	Pediatrics Physician
3	363L00000X	Nurse Practitioner
4	207R00000X	Internal Medicine Physician
5	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
6	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205886926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON CARE, LLC

Provider Business Mailing Address
First Line	:	915 WEST MICHIGAN ST
Second Line	:
City	:	SIDNEY
State	:	OH
Zip	:	45365-2401
Country	:	US
Telephone Number	:	937-498-5513
Fax Number	:	937-497-5674

Provider Business Practice Location Address
First Line	:	915 W. MICHIGAN STREET
Second Line	:	SUITE 100
City	:	SIDNEY
State	:	OH
Zip	:	45365
Country	:	US
Telephone Number	:	937-419-8049
Fax Number	:	937-419-8050

Authorized Official
Title or Position	:	CFO
Name	:	JULIE A COVAULT
Credential	:	CFO
Telephone Number	:	937-498-5402

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	04/06/2022

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Directions to “WILSON CARE, LLC ” Practice Location

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