Provider Demographics
NPI:1932160207
Name:PINEWEST OBGYN INC
Entity Type:Organization
Organization Name:PINEWEST OBGYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WELBORN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-885-0149
Mailing Address - Street 1:PO BOX 6415
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-6415
Mailing Address - Country:US
Mailing Address - Phone:336-885-0149
Mailing Address - Fax:336-885-0101
Practice Address - Street 1:306 WESTWOOD AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4341
Practice Address - Country:US
Practice Address - Phone:336-885-0149
Practice Address - Fax:336-885-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902425Medicaid
NC8902425Medicaid