Organization
WILSON INTERVENTIONAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW B WILSON MD (PRESIDENT)
(870) 425-3737
Entity
Organization
Contact information
Practice address
628 HOSPITAL DR STE 3D, MOUNTAIN HOME, AR 72653-2952
(870) 425-3737
(870) 425-3742
Mailing address
PO BOX 2008, MOUNTAIN HOME, AR 72654-2008
(870) 425-3737
(870) 425-3742
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
N-8297
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149277002
—
AR
Enumeration date
10/04/2006
Last updated
08/27/2010
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