Healthcare Provider Details

I. General information

NPI: 1528554631
Provider Name (Legal Business Name): BETHANY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 KIMEL FOREST DR STE 100
WINSTON SALEM NC
27103-6084
US

IV. Provider business mailing address

507 N LINDSAY ST
HIGH POINT NC
27262-4303
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-0029
  • Fax: 336-899-2176
Mailing address:
  • Phone: 336-883-0029
  • Fax: 336-899-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LENIN J PETERS
Title or Position: CEO
Credential: MD
Phone: 336-883-0029