NPIMap

Organization Active NPI

Wilson Interventional Clinic PA

  • Vascular & Interventional Radiology Physician
  • Mountain Home, AR
National Provider Identifier
1467547141
Registry record updated Aug 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
N-8297 Issued in AR
Legal business name
WILSON INTERVENTIONAL CLINIC PA
Practice address
628 Hospital Dr Ste 3D
Mountain Home, AR 72653-2952
Phone
(870) 425-3737
Fax
(870) 425-3742
NPI assigned
Oct 4, 2006
Last updated
Aug 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2010

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

Authorized official

Name
Matthew B Wilson, MDNPI 1578538575
Title
President
Phone
(870) 425-3737

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X N-8297 AR Primary

Addresses

Primary practice location

628 Hospital Dr Ste 3D
Mountain Home, AR 72653-2952

Mailing address

PO Box 2008
Mountain Home, AR 72654-2008
Phone (870) 425-3737

Other identifiers 1

IdentifierTypeStateIssuer
149277002MedicaidAR

National Provider Directory

National Provider Directory

Locations

628 Hospital Dr
Ste 3D
Mountain Home, AR 72653
Phone (870) 425-3737

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282867200000",
    "number": "1467547141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2008",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726542008",
            "telephone_number": "870-425-3737",
            "fax_number": "870-425-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 HOSPITAL DR STE 3D",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532952",
            "telephone_number": "870-425-3737",
            "fax_number": "870-425-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON INTERVENTIONAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2010-08-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-425-3737",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "AR",
            "license": "N-8297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149277002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; 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.