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Organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Active
Organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Active
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Other names
Peace Haven Internal Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Authorized official
MR. LEWIS S THORP III (PRESIDENT CEO)
(336) 721-3900
Entity
Organization
Contact information
Practice address
1930 NORTH PEACE HAVEN RD, WINSTON SALEM, NC 27106-4817
(336) 760-5400
(336) 760-0254
Mailing address
1930 NORTH PEACE HAVEN RD, WINSTON SALEM, NC 27106-4817
(336) 760-5400
(336) 760-0254
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2317728F
MEDICARE GROUP NUMBER
NC
05
—
890237T
—
NC
Enumeration date
08/23/2005
Last updated
04/10/2008
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