Wilmington Medical Group PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WILMINGTON MEDICAL GROUP PA

Practice address

308 Hwy 17 N
Holly Ridge, NC 28445-7828

Phone

(910) 329-1707

Fax

(910) 251-7777

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

James Henry Pridgen, M.D.

Title

Medical Director

Phone

(910) 329-1707

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Holly Ridge Healthcare PA Doing business as

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1295871705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925A OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284032334",
            "telephone_number": "910-251-8851",
            "fax_number": "910-251-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 HWY 17 N",
            "city": "HOLLY RIDGE",
            "state": "NC",
            "postal_code": "284457828",
            "telephone_number": "910-329-1707",
            "fax_number": "910-251-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "PRIDGEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "910-329-1707",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012R8",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "012R8",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "230038",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holly Ridge Healthcare PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maranda D Tamson
• Topsail Pediatric Therapy, PLLC
• Elizabeth Margaret Vliet, BSN, RN
• Jessica Clark Walker
• Lindsay C Webb, M.A., CCC-SLP
• Robert Steven Woods, SOIDC

• Family Medicine Physician in Holly Ridge, NC
• Providers in Holly Ridge, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.