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NPI Code Detail

MEDICARE: BEN WILLIAM WILSON JR. MD

MEDICARE: BEN WILLIAM WILSON JR. MD
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician23493SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2593303026005OTHERSCBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558364109
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEN WILLIAM WILSON JR. MD
Provider Business Mailing Address
First Line : 10701 ANDERSON RD
Second Line :
City : EASLEY
State : SC
Zip : 29642-9309
Country : US
Telephone Number : 864-295-2500
Fax Number :
Provider Business Practice Location Address
First Line : 10701 ANDERSON RD
Second Line :
City : EASLEY
State : SC
Zip : 29642-9309
Country : US
Telephone Number : 864-295-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 01/13/2015

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Directions to “ BEN WILLIAM WILSON JR. MD” Practice Location

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