Organization
WILKES PHYSICIAN NETWORK, INC.
Active
Parent organization
WILKES PHYSICIAN NETWORK, INC.
Other names
Wound Healing Center of Wilkes Regional Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILKES PHYSICIAN NETWORK, INC.
Authorized official
FRIEDA M LOWDER (SR VICE PRESIDENT)
(704) 403-4146
Entity
Organization
Contact information
Practice address
1900 W PARK DR, SUITE-B, NORTH WILKESBORO, NC 28659-3563
(336) 903-7100
(336) 903-7147
Mailing address
1900 W PARK DR, SUITE-B, NORTH WILKESBORO, NC 28659-3563
(336) 903-7100
(336) 903-7147
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2335816
MEDICARE PTAN, GROUP (WPN)
NC
05
—
5922043
—
NC
Enumeration date
11/01/2012
Last updated
01/18/2013
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