1851628325 NPI number — WILKES PHYSICIAN NETWORK, INC.

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 1851628325 NPI number — WILKES PHYSICIAN NETWORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILKES PHYSICIAN NETWORK, INC.
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:
NORTHWEST CAROLINA WOMEN'S 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:
1851628325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 WILLOW LN
Provider Second Line Business Mailing Address:
NORTHWEST CAROLINA WOMEN'S CENTER
Provider Business Mailing Address City Name:
NORTH WILKESBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28659-3551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-667-2232
Provider Business Mailing Address Fax Number:
336-667-2235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 WILLOW LN
Provider Second Line Business Practice Location Address:
NORTHWEST CAROLINA WOMEN'S CENTER
Provider Business Practice Location Address City Name:
NORTH WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28659-3551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-667-2232
Provider Business Practice Location Address Fax Number:
336-667-2235
Provider Enumeration Date:
11/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOWDER
Authorized Official First Name:
FRIEDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR. VICE PRESIDENT
Authorized Official Telephone Number:
704-403-4146

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2335816 . This is a "MEDICARE PTAN, GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5913875 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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