Wake Forest University Baptist Medical Center Community Physicians

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS

Doing business as

Northwest Digestive Health

Practice address

1916 W Park Dr
North Wilkesboro, NC 28659-3563

Phone

(336) 903-2900

Fax

(336) 903-2908

NPI assigned

May 10, 2007

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 2

Other names 1

• Northwest Digestive Health Doing business as

Part of

Peace Haven Urgent Care

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": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1912111766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 WEST PARK DRIVE",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "28659",
            "telephone_number": "336-721-3900",
            "fax_number": "336-903-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 W 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": "2007-05-10",
        "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": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906867",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2317728V",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Digestive Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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 (Wilkesboro Internal Medicine)
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Walgreen Co (Walgreens #17155)

• Gastroenterology Physician in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• Gastroenterology 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.