Provider Demographics
NPI:1205160165
Name:WINGATE COLLEGE, INC
Entity type:Organization
Organization Name:WINGATE COLLEGE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF WINGATE UNIVERSITY
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-233-8218
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-0159
Mailing Address - Country:US
Mailing Address - Phone:704-233-8102
Mailing Address - Fax:704-233-8104
Practice Address - Street 1:211A E WILSON ST
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174-9664
Practice Address - Country:US
Practice Address - Phone:704-233-8102
Practice Address - Fax:704-233-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801127261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5080713OtherAETNA
NC279087OtherMAMSI
NC891166JMedicaid
NC0108057OtherUNITED HEALTHCARE
NC1166JOtherBCBS
NC469196OtherOTHER
NC0108057OtherUNITED HEALTHCARE