1609162098 NPI number — NORTH CAROLINA BAPTIST HOSPITAL

Table of content: (NPI 1609162098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609162098 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:
WAKE FOREST BAPTIST MEDICAL 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:
1609162098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28275-1730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-716-2669
Provider Business Mailing Address Fax Number:
336-716-6359

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:
27157-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-2669
Provider Business Practice Location Address Fax Number:
336-716-6359
Provider Enumeration Date:
06/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LAMBETH
Authorized Official First Name:
DONNY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-716-3003

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  3400664386 , 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: 3400664386 . This is a "CLIA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6571 . This is a "THE JOINT COMMISSION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: H0011 . This is a "STATE LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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