1770628208 NPI number — WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER

Table of content: NICHOLE PAIGE ALEXANDER RPH (NPI 1093363327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770628208 NPI number — WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILKES FAMILY HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770628208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1534 WEST D ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WILKESBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28659-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-667-4178
Provider Business Mailing Address Fax Number:
336-667-0938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1534 WEST D ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28659-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-667-4178
Provider Business Practice Location Address Fax Number:
336-667-0938
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORP
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
336-721-3900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2317728S . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5906393 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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