Healthcare Provider Details

I. General information

NPI: 1134731227
Provider Name (Legal Business Name): WAKE FOREST UNIVERSITY HEALTH SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MOONEY ST
WINSTON SALEM NC
27103-3032
US

IV. Provider business mailing address

1901 MOONEY ST
WINSTON SALEM NC
27103-3027
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4207
  • Fax: 336-713-3244
Mailing address:
  • Phone: 336-716-4207
  • Fax: 336-713-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID WILLIAM ZAAS
Title or Position: PRESIDENT
Credential: MD
Phone: 336-713-4944