Provider Demographics
NPI:1447281845
Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Entity type:Organization
Organization Name:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRES, WFU HEALTH SCIENCES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-716-4424
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-718-4970
Mailing Address - Fax:
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-4970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013K1Medicaid
NC0228FOtherBCBS OF NC
NC89013K1Medicaid