MEDICARE: WILKES FAMILY HEALTH CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	103388	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D0277V	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154329365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILKES FAMILY HEALTH CENTER, PA

Provider Business Mailing Address
First Line	:	1534 W D ST
Second Line	:
City	:	N WILKESBORO
State	:	NC
Zip	:	28659-3528
Country	:	US
Telephone Number	:	336-667-4178
Fax Number	:	336-667-0938

Provider Business Practice Location Address
First Line	:	1534 W D ST
Second Line	:
City	:	N WILKESBORO
State	:	NC
Zip	:	28659-3528
Country	:	US
Telephone Number	:	336-667-4178
Fax Number	:	336-667-0938

Authorized Official
Title or Position	:	MANAGER
Name	:	GRACE S LAMBERT
Credential	:
Telephone Number	:	336-667-4178

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/21/2022

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