Provider Demographics
NPI:1871294934
Name:THE CHILDREN'S CLINIC OF WINSTON-SALEM
Entity type:Organization
Organization Name:THE CHILDREN'S CLINIC OF WINSTON-SALEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-815-4890
Mailing Address - Street 1:380 KNOLLWOOD ST STE H298
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1884
Mailing Address - Country:US
Mailing Address - Phone:336-815-4890
Mailing Address - Fax:
Practice Address - Street 1:1400 WESTGATE CENTER DR STE 206
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3104
Practice Address - Country:US
Practice Address - Phone:336-815-4890
Practice Address - Fax:336-799-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care