Provider Demographics
NPI:1154329365
Name:WILKES FAMILY HEALTH CENTER, PA
Entity Type:Organization
Organization Name:WILKES FAMILY HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-667-4178
Mailing Address - Street 1:1534 W D ST
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3528
Mailing Address - Country:US
Mailing Address - Phone:336-667-4178
Mailing Address - Fax:336-667-0938
Practice Address - Street 1:1534 W D ST
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3528
Practice Address - Country:US
Practice Address - Phone:336-667-4178
Practice Address - Fax:336-667-0938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D0277VOtherBCBS
NC089012U7Medicaid
NC089012U7Medicaid