Healthcare Provider Details

I. General information

NPI: 1689878803
Provider Name (Legal Business Name): WAKE FOREST UNIVERSITY HEALTH SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SHEPHERD ST SUITE 201
WINSTON SALEM NC
27103-1628
US

IV. Provider business mailing address

PO BOX 344
WINSTON SALEM NC
27102-0344
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4039
  • Fax:
Mailing address:
  • Phone: 336-716-2255
  • Fax:

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: WILLIAM APPLEGATE
Title or Position: INTERIM PRES, WFU HEALTH SCIENCES
Credential: MD
Phone: 336-716-4424