1841049913 NPI number — WAKE FOREST BAPTIST IMAGING LLC

Table of content: (NPI 1841049913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841049913 NPI number — WAKE FOREST BAPTIST IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAKE FOREST BAPTIST IMAGING LLC
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:
Provider Other Organization Name Type Code:
6
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:
1841049913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000 DEPT 842
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38148-0842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-261-2306
Provider Business Mailing Address Fax Number:
855-588-3545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 NORTHLINE AVE STE 3120-101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-7814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-765-5722
Provider Business Practice Location Address Fax Number:
336-765-5723
Provider Enumeration Date:
05/13/2024

Additional Information

Authorized Official

Authorized Official Last Name:
STOUT
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
615-261-2306

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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