Provider Demographics
NPI:1134731227
Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Entity type:Organization
Organization Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, HEALTH SYSTEM, WFBH
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-716-8021
Mailing Address - Street 1:1901 MOONEY ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3032
Mailing Address - Country:US
Mailing Address - Phone:336-716-4207
Mailing Address - Fax:336-713-3244
Practice Address - Street 1:1901 MOONEY ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3032
Practice Address - Country:US
Practice Address - Phone:336-716-4207
Practice Address - Fax:336-713-3244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies