Organization
WAKE FOREST HEALTH NETWORK LLC
Active
Other names
Pinewest OB-Gyn at Premier
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL MARS HOWERTON MD (SR VP NETWORK PHYS & HS CMO)
(336) 716-1331
Entity
Organization
Contact information
Practice address
4515 PREMIER DR, SUITE 405, HIGH POINT, NC 27265-8357
(336) 885-0149
(336) 885-2933
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-1331
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5913500
—
NC
Enumeration date
05/28/2013
Last updated
09/02/2021
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