NPIMap

Organization Active NPI

Oldtown Immediate Care, PA

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1194060368
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
40655 Issued in NC
Legal business name
OLDTOWN IMMEDIATE CARE, PA
Practice address
3690 Reynolda Rd
Winston Salem, NC 27106-2240
Phone
(336) 922-1363
Fax
(336) 922-0723
NPI assigned
Nov 29, 2012
Last updated
Dec 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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

Authorized official

Name
Henry Franklin Tripp Jr., M.D
Title
Medical Director
Phone
(336) 993-3146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 40655 NC Primary

Addresses

Primary practice location

3690 Reynolda Rd
Winston Salem, NC 27106-2240

Mailing address

PO Box 30575
Winston Salem, NC 27130-0575
Phone (336) 922-1363

National Provider Directory

National Provider Directory

Locations

3690 Reynolda Rd
Winston Salem, NC 27106
Phone (336) 922-1363

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1194060368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30575",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271300575",
            "telephone_number": "336-922-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3690 REYNOLDA RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271062240",
            "telephone_number": "336-922-1363",
            "fax_number": "336-922-0723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLDTOWN IMMEDIATE CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "TRIPP",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "FRANKLIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "336-993-3146",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "40655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; 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.