Provider Demographics
NPI:1801832886
Name:WEST WILKES MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WEST WILKES MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:NEWMAN
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-973-7050
Mailing Address - Street 1:171 W WILKES MEDICAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:NC
Mailing Address - Zip Code:28624-8925
Mailing Address - Country:US
Mailing Address - Phone:336-973-7050
Mailing Address - Fax:336-973-5154
Practice Address - Street 1:171 W WILKES MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:NC
Practice Address - Zip Code:28624-8925
Practice Address - Country:US
Practice Address - Phone:336-973-7050
Practice Address - Fax:336-973-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900459Medicaid
NC5900459Medicaid