Provider Demographics
NPI:1881655876
Name:WILKES WOMENS CARE, PA
Entity Type:Organization
Organization Name:WILKES WOMENS CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-667-7171
Mailing Address - Street 1:408 8TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4167
Mailing Address - Country:US
Mailing Address - Phone:336-667-7171
Mailing Address - Fax:336-667-1095
Practice Address - Street 1:408 8TH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4130
Practice Address - Country:US
Practice Address - Phone:336-667-7171
Practice Address - Fax:336-667-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890297MMedicaid
NC0297MOtherBCBS OFFICE PROVIDER #
NC890297MMedicaid
NC0297MOtherBCBS OFFICE PROVIDER #
NCG07022Medicare UPIN