Organization
WAVERLY MEDICAL PRACTICE,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH ARTHUR WILKINSON M.D. (OWNER)
(740) 947-2383
Entity
Organization
Contact information
Practice address
207 ST ANNS LN, WAVERLY, OH 45690-1040
(740) 708-5478
(740) 947-5720
Mailing address
207 SAINT ANNS LN, WAVERLY, OH 45690-1040
(740) 708-5478
(740) 947-5720
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
35024770
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9470880
—
OH
Enumeration date
11/28/2007
Last updated
03/21/2008
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