Wake Forest University Baptist Medical Center Community Physicians

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

Doing business as

Marlette Family Practice

Practice address

5175 Old Clemmons School Road
Clemmons, NC 27012

Phone

(336) 778-0200

Fax

(336) 778-0202

NPI assigned

Jun 14, 2007

Last updated

Apr 10, 2008By the provider in NPPES

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 III

Title

President Ceo

Phone

(336) 721-3900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marlette Family Practice Doing business as

Part of

Winston East OB GYN

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": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1871797688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5175 OLD CLEMMONS SCHOOL ROAD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129394",
            "telephone_number": "336-778-0200",
            "fax_number": "336-778-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5175 OLD CLEMMONS SCHOOL ROAD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "27012",
            "telephone_number": "336-778-0200",
            "fax_number": "336-778-0202"
        }
    ],
    "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": "2007-06-14",
        "last_updated": "2008-04-10",
        "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": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2317728W",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marlette Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victoria Cunnea, DC, PLLC (Optimum Potential Chiropractic)
• David M Villanueva, D.O.
• Scott L Vogler, MD
• W E Berry OD PA
• Ashlynn Wagner
• Wal-Mart Stores East LP (Walmart Pharmacy 10-6243)
• Walgreen Co (Walgreens #19937)
• Walgreen Co (Walgreens #09558)
• Danielle Sherie Walker, PHARM.D.
• Sarah Elizabeth Walls

• Family Medicine Physician in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.