1386778926 NPI number — NORTH CAROLINA BAPTIST HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386778926 NPI number — NORTH CAROLINA BAPTIST HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CAROLINA BAPTIST HOSPITAL
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:
DBA DOWNTOWN HEALTH PLAZA
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:
1386778926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27157-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-713-0027
Provider Business Mailing Address Fax Number:
336-716-6705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157-1191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-3539
Provider Business Practice Location Address Fax Number:
336-716-3153
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIBERT
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT AND COO OF HEALTH SYSTEM
Authorized Official Telephone Number:
336-716-3005

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  H0011 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5906592 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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