Provider Demographics
NPI:1376117176
Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Entity Type:Organization
Organization Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER, BESTHEALTH FOR BU
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-716-3379
Mailing Address - Street 1:486 N PATTERSON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4261
Mailing Address - Country:US
Mailing Address - Phone:336-713-3868
Mailing Address - Fax:336-716-4941
Practice Address - Street 1:486 N PATTERSON AVE FL 5
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4261
Practice Address - Country:US
Practice Address - Phone:336-713-3868
Practice Address - Fax:336-716-4941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center