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General NPI Number Information
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NPI Number | 1639454499
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Entity Type | Organization
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Legal Business Name | WAKE FOREST UNIVERSITY HEALTH SCIENCES
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 1303 GREENSBORO STREET EXT
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City | LEXINGTON
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State | NC
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Zip | 27295-1924
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Country | US
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Telephone | 336-716-2255
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Fax | 336-716-3202
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Provider Business Mailing Address
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Address Line | WAKE FOREST UNIVERSITY HEALTH SCIENCES PO BOX 890355
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City | CHARLOTTE
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State | NC
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Zip | 28289-0355
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Country | US
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Telephone | 336-716-2255
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Fax | 336-716-3202
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Authorized Official
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Title or Position | PRESIDENT & COO
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Name | THOMAS E SIBERT
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Credential | MD
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Telephone | 336-716-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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