Basic Information
| Provider Information | |||||||||
| NPI: | 1881632339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILMINGTON HEALTH PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103413300 | ||||||||
| FaxNumber: | 9108152882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103413300 | ||||||||
| FaxNumber: | 9108152882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHACE | ||||||||
| AuthorizedOfficialFirstName: | CHASITY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUSINESS SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9103413384 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 73991 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | CC5031 | 01 | NC | RAILROAD MEDICARE | OTHER | 0294V | 01 | NC | BCBS NC | OTHER | 890294V | 05 | NC | MEDICAID | CC5032 | 01 | NC | RAILROAD MEDICARE | OTHER | CC5030 | 01 | NC | RAILROAD MEDICARE | OTHER |