MEDICARE: SMEG FAMILY MENTAL HEALTH

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	5003235	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1578986931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMEG FAMILY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	610A OLD TAR VILLAGE RD
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-7936
Country	:	US
Telephone Number	:	252-364-8972
Fax Number	:	252-364-8971

Provider Business Practice Location Address
First Line	:	610A OLD TAR VILLAGE RD
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-7936
Country	:	US
Telephone Number	:	252-364-8972
Fax Number	:	252-364-8971

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. RICHARD WILSON JR.
Credential	:
Telephone Number	:	252-364-8972

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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Directions to “SMEG FAMILY MENTAL HEALTH ” Practice Location

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