Provider Demographics
NPI:1649261785
Name:WHAP, PA
Entity type:Organization
Organization Name:WHAP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-765-9350
Mailing Address - Street 1:2927 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4005
Mailing Address - Country:US
Mailing Address - Phone:336-765-9350
Mailing Address - Fax:336-760-4255
Practice Address - Street 1:3015 MAPLEWOOD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4075
Practice Address - Country:US
Practice Address - Phone:336-765-9350
Practice Address - Fax:336-760-4255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHAP, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-28
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909007Medicaid
NC8902043Medicaid
NC5909008Medicaid
NC5909008Medicaid
NC230109Medicare ID - Type Unspecified
NC5909007Medicaid