| Joseph L Wilson Md Inc | |
|
1901 Mission 66 Vicksburg MS 39180-3711 | |
| (601) 636-0097 | |
| (601) 629-9969 |
| Full Name | Joseph L Wilson Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1901 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Joseph L Wilson (PRESIDENT) |
| Authorized Official Contact | 6016360097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joseph L Wilson Md Inc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 | Joseph L Wilson Md Inc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 |
| NPI Number | 1730287707 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0840214730 |
|---|---|
| Medicare Enrollment ID | O20060118000747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730287707 | NPI | - | NPPES |
| 01976796 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 10040 (Mississippi) | Primary |
| Provider Name | Joseph L Wilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568560530 PECOS PAC ID: 9537183439 Enrollment ID: I20060123000424 |
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