Provider Demographics
NPI:1376799965
Name:WILKES PHYSICIAN NETWORK, INC.
Entity Type:Organization
Organization Name:WILKES PHYSICIAN NETWORK, INC.
Other - Org Name:WILKES REGIONAL HOSPITALIST GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:1370 W D ST
Mailing Address - Street 2:WILKES REGIONAL HOSPITALIST GROUP
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3506
Mailing Address - Country:US
Mailing Address - Phone:336-903-8700
Mailing Address - Fax:336-651-8196
Practice Address - Street 1:1370 W D ST
Practice Address - Street 2:WILKES REGIONAL HOSPITALIST GROUP
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3506
Practice Address - Country:US
Practice Address - Phone:336-903-8700
Practice Address - Fax:336-651-8196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES PHYSICIAN NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-14
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950380Medicaid
NC5950380Medicaid