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	207Q00000X	Family Medicine Physician		NC

Other Identifiers

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

General Provider Information

NPI Number	:	1417940636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

Provider Business Mailing Address
First Line	:	509 BROOKDALE DR
Second Line	:	YOUNG FAMILY PRACTICE
City	:	STATESVILLE
State	:	NC
Zip	:	28677-4107
Country	:	US
Telephone Number	:	704-924-7992
Fax Number	:	704-924-7950

Provider Business Practice Location Address
First Line	:	509 BROOKDALE DR
Second Line	:	YOUNG FAMILY PRACTICE
City	:	STATESVILLE
State	:	NC
Zip	:	28677-4107
Country	:	US
Telephone Number	:	704-924-7992
Fax Number	:	704-924-7950

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MR. LEWIS S THORP III
Credential	:
Telephone Number	:	336-659-5116

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1750798013 — MS. JAMIE MARIE LOCKARD FNP-C
Practice Location Address:

527 BROOKDALE DR
STATESVILLE, NC
28677-4107

Practice Phone: 704-278-4053
Practice Fax:

1982606281 — ROCCO JOSEPH TRITICO M.D.
Practice Location Address:

557 BROOKDALE DR
STATESVILLE, NC
28677-4107

Practice Phone: 704-878-4510
Practice Fax:

1801894860 — DR. KURT PETTERSON DPM
Practice Location Address:

533 BROOKDALE DR
STATESVILLE, NC
28677-4107

Practice Phone: 704-872-2028
Practice Fax: 704-872-3390

1417944224 — IREDELL MEMORIAL HOSPITAL, INCORPORATED
Practice Location Address:

557 BROOKDALE DR
STATESVILLE, NC
28677-4107

Practice Phone: 704-873-5661
Practice Fax: 704-878-4611

1093797045 — KEVIN PATRICK MCMULLEN MD
Practice Location Address:

557 BROOKDALE DR
STATESVILLE, NC
28677-4107

Practice Phone: 704-878-4615
Practice Fax: 704-878-7193

1114905601 — DR. THOMAS GASTON M.D.
Practice Location Address:

557 BROOKDALE DR
STATESVILLE, NC
28677-4107

Practice Phone: 704-838-5166
Practice Fax:

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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.