1114163300 NPI number — WILMINGTON HEALTH PLLC

Table of content: (NPI 1114163300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114163300 NPI number — WILMINGTON HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILMINGTON HEALTH PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONVENIENT CARE AT PORTER'S NECK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114163300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28401-7307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-617-6705
Provider Business Mailing Address Fax Number:
910-431-4048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8108B MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28411-9386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-341-3300
Provider Business Practice Location Address Fax Number:
910-251-2067
Provider Enumeration Date:
12/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOVELESS
Authorized Official First Name:
JEANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OA
Authorized Official Telephone Number:
910-796-7730

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  73991 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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