Organization
WILSON ENT PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY LEE WILSON MD (PRESEIDENT)
(270) 651-2433
Entity
Organization
Contact information
Practice address
102 C PHYSICIANS BLVD, GLASGOW, KY 42141
(270) 651-2433
(270) 651-2949
Mailing address
PO BOX 1088, GLASGOW, KY 42142-1088
(270) 651-2433
(270) 651-2949
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
34426
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000065313
ANTHEM ID
KY
05
—
65932428
—
KY
01
—
DN6242
RAILROAD MEDICARE
KY
Enumeration date
09/22/2006
Last updated
01/15/2009
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