Organization
WAKE FOREST BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Active
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Other names
Winston East Pediatrics
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
2295 EAST 14TH ST, STE 100, WINSTON SALEM, NC 27105
(336) 725-0514
(336) 725-2173
Mailing address
2295 EAST 14TH ST, STE 100, WINSTON SALEM, NC 27105
(336) 725-0514
(336) 725-2173
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2317728I
MEDICARE GROUP NUMBER
NC
05
—
890228U
—
NC
Enumeration date
08/23/2005
Last updated
04/10/2008
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