Provider Demographics
NPI:1144211301
Name:NORTH CAROLINA BAPTIST HOSPITAL
Entity Type:Organization
Organization Name:NORTH CAROLINA BAPTIST HOSPITAL
Other - Org Name:WAKE FOREST BAPTIST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, AH WFB & DMC
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-713-3327
Mailing Address - Street 1:PO BOX 751730
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1730
Mailing Address - Country:US
Mailing Address - Phone:336-716-3539
Mailing Address - Fax:336-716-6881
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-0277
Practice Address - Fax:336-716-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0011282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400047Medicaid
NCH0011OtherLICENSE NUMBER
NC001GROtherBLUE CROSS BLUE SHIELD
NC0441KOtherBLUE CROSS BLUE SHIELD
NC7902337Medicaid
NC001GPOtherBLUE CROSS BLUE SHIELD
NC001GROtherBLUE CROSS BLUE SHIELD
NC340047Medicare PIN