Provider Demographics
NPI:1093198616
Name:WAKE FOREST BAPTIST HEALTH
Entity Type:Organization
Organization Name:WAKE FOREST BAPTIST HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-721-3937
Mailing Address - Street 1:6630 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9504
Mailing Address - Country:US
Mailing Address - Phone:336-716-9253
Mailing Address - Fax:
Practice Address - Street 1:6630 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9504
Practice Address - Country:US
Practice Address - Phone:336-716-9253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001005813261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care