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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2317728U	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	:	1588657605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

Provider Business Mailing Address
First Line	:	304 MOUNTAINVIEW ROAD
Second Line	:
City	:	KING
State	:	NC
Zip	:	27021-2468
Country	:	US
Telephone Number	:	336-983-6898
Fax Number	:	336-983-6921

Provider Business Practice Location Address
First Line	:	304 MOUNTAIN VIEW RD
Second Line	:
City	:	KING
State	:	NC
Zip	:	27021-8768
Country	:	US
Telephone Number	:	336-983-6898
Fax Number	:	336-983-6921

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	04/10/2008

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

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