Provider Demographics
NPI:1609850551
Name:WILCOX, STEPHEN N (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:N
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-8722
Mailing Address - Fax:
Practice Address - Street 1:2 STONECREST DR
Practice Address - Street 2:FAMILY URGENT CARE CENTER
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-9391
Practice Address - Country:US
Practice Address - Phone:304-525-2273
Practice Address - Fax:304-525-1148
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429063Medicaid
WVP00372381OtherMEDICARE-RR PROVIDER NUMBER
WV1809769000Medicaid
WV4116383Medicare PIN
WV1809769000Medicaid
WVP00372381OtherMEDICARE-RR PROVIDER NUMBER