Individual
DR. JACK COOK WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
612 E 9TH ST, MOUNTAIN HOME, AR 72653-4804
(870) 424-3652
Mailing address
924 CAPITOL DR, MOUNTAIN HOME, AR 72653-2053
(870) 424-3652
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C3223
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16022000000
QUALCHOICE PROVIDER ID #
AR
01
—
55740
BLUE CROSS BLUE SHIELD ID
AR
Enumeration date
12/02/2005
Last updated
07/09/2007
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us