Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 WEST PARK DR
NORTH WILKESBORO NC
28659-3563
US

IV. Provider business mailing address

1916 WEST PARK DR
NORTH WILKESBORO NC
28659-3563
US

V. Phone/Fax

Practice location:
  • Phone: 336-903-2900
  • Fax: 336-903-2908
Mailing address:
  • Phone: 336-903-2900
  • Fax: 336-903-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. LEWIS S THORP IV
Title or Position: PRESIDENT CEO
Credential:
Phone: 336-721-3900