Provider Demographics
NPI:1487822235
Name:WILKES REGIONAL PHYSICIANS, INC.
Entity Type:Organization
Organization Name:WILKES REGIONAL PHYSICIANS, INC.
Other - Org Name:WILKES SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-657-8110
Mailing Address - Street 1:1915 W PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3511
Mailing Address - Country:US
Mailing Address - Phone:336-651-8700
Mailing Address - Fax:336-651-8710
Practice Address - Street 1:1915 W PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3511
Practice Address - Country:US
Practice Address - Phone:336-651-8700
Practice Address - Fax:336-651-8710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WRMC HOSPITAL OPERATING CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV02BBCHKMedicare PIN
WVHO5174Medicare UPIN