Provider Demographics
NPI:1942359385
Name:NORTH CAROLINA BAPTIST HOSPITAL
Entity Type:Organization
Organization Name:NORTH CAROLINA BAPTIST HOSPITAL
Other - Org Name:WFUBMC AIRCARE CRITICAL CARE TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, WAKE FOREST BAPTIST MC
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-716-8021
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:336-716-3539
Mailing Address - Fax:336-716-3153
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:336-713-0277
Practice Address - Fax:336-716-6705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CAROLINA BAPTIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13653416L0300X, 3416L0300X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010095689Medicaid
SCQA149Medicaid
WV0226105000Medicaid
NC3406899Medicaid
NC342304Medicare Oscar/Certification