Basic Information
| Provider Information | |||||||||
| NPI: | 1336619063 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAKE FOREST UNIVERSITY HEALTH SCIENCES | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICAL CENTER BLVD ATTN: PROVIDER ENROLLMENT | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367132255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1814 WESTCHESTER DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022055 | ||||||||
| FaxNumber: | 3368022056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2018 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | HIGH | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OF HEALTH SYSTEM | ||||||||
| AuthorizedOfficialTelephone: | 3367168021 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.