Provider Demographics
NPI:1609162098
Name:NORTH CAROLINA BAPTIST HOSPITAL
Entity Type:Organization
Organization Name:NORTH CAROLINA BAPTIST HOSPITAL
Other - Org Name:WAKE FOREST BAPTIST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAMBETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-716-3003
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:336-716-2669
Mailing Address - Fax:336-716-6359
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:336-716-2669
Practice Address - Fax:336-716-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3400664386291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400664386OtherCLIA
NC6571OtherTHE JOINT COMMISSION
NCH0011OtherSTATE LICENSE