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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
Club Haven Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Authorized official
LEWIS S THORP III (PRESIDENT/CEO)
(336) 721-3900
Entity
Organization
Contact information
Practice address
2801 LYNDHURST AVE, WINSTON SALEM, NC 27103-4109
(336) 768-9575
(336) 774-1737
Mailing address
2801 LYNDHURST AVE, WINSTON SALEM, NC 27103-4109
(336) 768-9575
(336) 774-1737
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2317728X
MEDICARE GROUP NUMBER
NC
05
—
5908389
—
NC
Enumeration date
10/30/2007
Last updated
04/10/2008
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