Provider Demographics
NPI:1043252794
Name:WILSON IMAGING CENTER, LLC
Entity type:Organization
Organization Name:WILSON IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:336-852-3488
Mailing Address - Street 1:PO BOX 16984
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6984
Mailing Address - Country:US
Mailing Address - Phone:919-967-6646
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:2303 WELLINGTON DR SW
Practice Address - Street 2:SUITE D
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8620
Practice Address - Country:US
Practice Address - Phone:252-237-2659
Practice Address - Fax:252-237-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017WTOtherBLUE CROSS/BLUE SHIELD