Provider Demographics
NPI:1346218724
Name:NORTH CAROLINA BAPTIST HOSPITAL
Entity Type:Organization
Organization Name:NORTH CAROLINA BAPTIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, HEALTH SYSTEM, WFBH
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-716-8021
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:336-716-3153
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:336-716-3086
Practice Address - Fax:336-716-6203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CAROLINA BAPTIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-10
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0011261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400047Medicaid
NC342304Medicare PIN
NC3400047Medicaid