Provider Demographics
NPI:1700874369
Name:WILKES SURGICAL ASSOCIATES INC PA
Entity Type:Organization
Organization Name:WILKES SURGICAL ASSOCIATES INC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BOND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-667-5146
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1128
Mailing Address - Country:US
Mailing Address - Phone:336-667-5146
Mailing Address - Fax:336-667-2931
Practice Address - Street 1:1201 SCHOOL ST
Practice Address - Street 2:SUITE G
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2629
Practice Address - Country:US
Practice Address - Phone:336-667-5146
Practice Address - Fax:336-667-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902938Medicaid
SC0481610001OtherDMERC
NC8902938Medicaid
0575Medicare ID - Type UnspecifiedGROUP #