Wake Forest University Baptist Medical Center Community Physicians

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

Doing business as

Wilkesboro Internal Medicine

Practice address

1916 West Park Dr
North Wilkesboro, NC 28659-3563

Phone

(336) 903-2900

Fax

(336) 903-2908

NPI assigned

Aug 23, 2005

Organization subpart

Yes

Parent organization

WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANSAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Lewis S Thorp IV

Title

President Ceo

Phone

(336) 721-3900

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Wilkesboro Internal Medicine Doing business as

Part of

Peace Haven Urgent Care

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Wake Forest University Baptist Medical Center Community Physicians

  dba Young Family Practice

  • Family Medicine Physician
  • Statesville, NC
  • NPI 1417940636
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1013900356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 WEST PARK DR",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593563",
            "telephone_number": "336-903-2900",
            "fax_number": "336-903-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 WEST PARK DR",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593563",
            "telephone_number": "336-903-2900",
            "fax_number": "336-903-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "enumeration_date": "2005-08-23",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "THORP",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "336-721-3900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2317728J",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890196U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilkesboro Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Valerie B Vickers-Robinson, LPC
• Keara Vincent, DDS
• Mark Wages
• Wake Forest Baptist Health Care at Home, LLC (Wake Forest Bapatist Healthcare a Home, Community Care-Wilkes, Disable)
• Wake Forest University Baptist Medical Center (Wilkes Family Health Center)
• Wake Forest University Baptist Medical Center Community Physicians (Northwest Digestive Health)
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences

• Internal Medicine Physician in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.