Healthcare Provider Details

I. General information

NPI: 1124599089
Provider Name (Legal Business Name): WAKE FOREST UNIVERSITY HEALTH SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DR STE 201
HIGH POINT NC
27265-8356
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2035
  • Fax: 336-802-2524
Mailing address:
  • Phone: 336-713-9329
  • Fax: 336-716-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PAUL HIGH
Title or Position: PRESIDENT, HEALTH SYSTEM, WFBH
Credential: MD
Phone: 336-716-8021