Provider Demographics
NPI:1639302086
Name:WILKES PHYSICIAN NETWORK, INC.
Entity Type:Organization
Organization Name:WILKES PHYSICIAN NETWORK, INC.
Other - Org Name:ORTHOPAEDIC SPECIALISTS OF WILKES
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:
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:1917 W PARK DR
Mailing Address - Street 2:ORTHOPAEDIC SPECIALISTS OF WILKES
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3585
Mailing Address - Country:US
Mailing Address - Phone:336-903-7845
Mailing Address - Fax:336-903-7841
Practice Address - Street 1:1917 W PARK DR
Practice Address - Street 2:ORTHOPAEDIC SPECIALISTS OF WILKES
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3585
Practice Address - Country:US
Practice Address - Phone:336-903-7845
Practice Address - Fax:336-903-7841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES PHYSICIAN NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335816OtherMEDICARE GROUP PTAN