Provider Demographics
NPI:1851628325
Name:WILKES PHYSICIAN NETWORK, INC.
Entity Type:Organization
Organization Name:WILKES PHYSICIAN NETWORK, INC.
Other - Org Name:NORTHWEST CAROLINA WOMEN'S CENTER
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 1:1405 WILLOW LN
Mailing Address - Street 2:NORTHWEST CAROLINA WOMEN'S CENTER
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3551
Mailing Address - Country:US
Mailing Address - Phone:336-667-2232
Mailing Address - Fax:336-667-2235
Practice Address - Street 1:1405 WILLOW LN
Practice Address - Street 2:NORTHWEST CAROLINA WOMEN'S CENTER
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3551
Practice Address - Country:US
Practice Address - Phone:336-667-2232
Practice Address - Fax:336-667-2235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES PHYSICIAN NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-04
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335816OtherMEDICARE PTAN, GROUP
NC5913875Medicaid