Provider Demographics
NPI:1225139249
Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Entity Type:Organization
Organization Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Other - Org Name:WFU OPHTHALMIC CONSULTANTS
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM PRES, WFU HEALTH SCIENCES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-716-4424
Mailing Address - Street 1:1014 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1424
Mailing Address - Country:US
Mailing Address - Phone:336-274-2149
Mailing Address - Fax:
Practice Address - Street 1:1014 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1424
Practice Address - Country:US
Practice Address - Phone:336-274-2149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907377Medicaid
NC2326115CMedicare PIN