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1013900356

NPI Code Detail

MEDICARE: WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

MEDICARE: WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2317728J	OTHER	NC	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013900356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

Provider Business Mailing Address
First Line	:	1916 WEST PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3563
Country	:	US
Telephone Number	:	336-903-2900
Fax Number	:	336-903-2908

Provider Business Practice Location Address
First Line	:	1916 WEST PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3563
Country	:	US
Telephone Number	:	336-903-2900
Fax Number	:	336-903-2908

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MR. LEWIS S THORP IV
Credential	:
Telephone Number	:	336-721-3900

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	04/11/2008

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Directions to “WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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