Wilmington Family Practice PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

WILMINGTON FAMILY PRACTICE PLLC

Practice address

3971 Business 17 E
Bolivia, NC 28422-8675

Phone

(910) 500-6451

Fax

(910) 500-6458

NPI assigned

Nov 27, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Annette Crouse

Title

Office Manager

Phone

(910) 500-6451

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 2

• Center For Quality Care Doing business as
• WILMINGTON FAMILY PRACTICE Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Center for Quality Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wilmington Family Practice

  • Family Medicine Physician
  • Wilmington, NC
  • NPI 1588205397
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Marvin McKeithan, NP

  • Family Nurse Practitioner
  • Bolivia, NC
  • NPI 1821295668
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1194361923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3971 BUSINESS 17 E",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284228675",
            "telephone_number": "910-500-6451",
            "fax_number": "910-500-6458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3971 BUSINESS 17 E",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284228675",
            "telephone_number": "910-500-6451",
            "fax_number": "910-500-6458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-27",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "CROUSE",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "910-500-6451"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1669918223",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821295668",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992351910",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center For Quality Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WILMINGTON FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryleigh Weber, MS
• Carolyn Whitfield
• Lillie Williams, LCAS-A
• Ryan Williams
• Melissa J Willis, PT
• Joshua Brewster Winslow, MD
• Edward Woo, MD
• Anne Wrenn, RD
• Brent D Wright, MD
• Hailey Yates, PA-C

• Primary Care Clinic/Center in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.