NPIMap

Organization Active NPI

Wake Forest University

Doing business as Wake Forest University Sports Medicine

  • Physical Therapy Clinic/Center
  • Winston Salem, NC
National Provider Identifier
1265678817
Registry record updated Aug 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
WAKE FOREST UNIVERSITY
Doing business as
Wake Forest University Sports Medicine
Practice address
Wingate Road, Reynolds Gymnasium
Room 106
Winston-Salem, NC 27106
Phone
(336) 758-5620
Fax
(336) 758-6149
NPI assigned
Jan 5, 2009
Organization subpart
Yes
Parent organization
WAKE FOREST UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2015

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

Authorized official

Name
Greg Collins, ATC
Title
Assistant Athletic Director
Phone
(336) 758-5620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

Wingate Road, Reynolds Gymnasium
Room 106
Winston-Salem, NC 27106

Mailing address

Wingate Road, Reynolds Gymnasium
Room 106
Winston-Salem, NC 27106
Phone (336) 758-5620

Other names 1

  • Wake Forest University Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wake Forest Cardiac Rehab3 organizations share this tax ID, including this one
Part of
Wake Forest Cardiac Rehab

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

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.

NPI Registry JSON

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1265678817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WINGATE ROAD, REYNOLDS GYMNASIUM",
            "address_2": "ROOM 106",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27106",
            "telephone_number": "336-758-5620",
            "fax_number": "336-758-6149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WINGATE ROAD, REYNOLDS GYMNASIUM",
            "address_2": "ROOM 106",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27106",
            "telephone_number": "336-758-5620",
            "fax_number": "336-758-6149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST UNIVERSITY",
        "enumeration_date": "2009-01-05",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "ASSISTANT ATHLETIC DIRECTOR",
        "authorized_official_telephone_number": "336-758-5620",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wake Forest University Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 19, 2015; 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.