Wilson Immediate Care, PA
Organization Active NPI Internal Medicine Physician · Wilson, NC
NPI 1679521983 · NPPES record last updated Apr 4, 2011
Key facts
- NPI
- 1679521983
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 90900464 (NC)
- Legal business name
- WILSON IMMEDIATE CARE, PA
- Practice address
- 1725 S. Tarboro Street
Wilson, NC 27893 - Phone
- (252) 237-2891
- Fax
- (252) 237-0115
- NPI assigned
- May 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Lawrence David Krabill, MD
- Title
- President
- Phone
- (252) 237-2891
Practitioners 5
-
Kent Thomas Anderson, M.D.
-
Chanson Albert Devaul, D.O.
-
James Milton Fitch, PA-C
-
Lawrence David Krabill, M.D.
-
William A Munn, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0242372 | Wilson Immediate Care PA | Certificate of waiver | Dec 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060314000555 | NC | Part B Supplier - Clinic/Group Practice | 5395752448 |
Receives reassigned benefits from 5 practitioners Practice locations: Wilson, NC |
National Provider Directory
Locations
1725 Tarboro St SW
Wilson, NC 27893
Phone (252) 237-2891
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 25535 | NC | |
| Family Medicine Physician |
207Q00000X | 94-00464 | NC | |
| Internal Medicine Physician |
207R00000X | 90900464 | NC | Yes |
| Urgent Care Clinic/Center | 261QU0200X | 261QUO200X |
Addresses
Primary practice location
1725 S. Tarboro Street
Wilson, NC 27893
Mailing address
1725 S. Tarboro Street
Wilson, NC 27893
Phone (252) 237-2891
Other providers in Wilson, NC
- Wilson Gastroenterology PA
- Wilson Greene Mental Health
- Wilson Heart P a
- Wilson House LLC
- Wilson Imaging Center, LLC
- Wilson Internal Medicine PA
- Wilson Medical Associates PA
- Wilson Medical Center
- Wilson Medical Center, Inc.
- Wilson Medical Center, Inc.
All providers in Wilson, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.