Basic Information
| Provider Information | |||||||||
| NPI: | 1396729265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | GOODE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367187950 | ||||||||
| FaxNumber: | 3367187989 | ||||||||
| Practice Location | |||||||||
| Address1: | ROBINHOOD MEDICAL PLAZA, BLDG 200 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271065475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367187950 | ||||||||
| FaxNumber: | 3367187989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 24553 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 24553 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | MD447695 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 203709000 | 05 | WV | MEDICAID | 4574823 | 01 | AETNA | OTHER | 8985747 | 05 | NC | MEDICAID | 200043945 | 01 | RR MEDICARE | OTHER | 40254 | 01 | MEDCOST | OTHER | 85747 | 01 | BCBS | OTHER | 2678 | 01 | PARTNERS | OTHER | 6400264 | 05 | VA | MEDICAID | Q24553 | 05 | SC | MEDICAID |