Active NPI
Bethany Medical Center
- Anatomic Pathology & Clinical Pathology Physician
- Wilkesboro, NC
National Provider Identifier
1992133870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- Legal business name
- BETHANY MEDICAL CENTER
- Practice address
- 100 N Bridge St
Suite C
Wilkesboro, NC 28697-2488 - Phone
- (336) 883-0029
- Fax
- (336) 899-2188
- NPI assigned
- Oct 31, 2013
- Last updated
- Oct 13, 2025
- Organization subpart
- Yes
- Parent organization
- BETHANY MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mandy Womble
- Title
- Cfo
- Phone
- (336) 883-0029
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician | 207ZC0500X | NC | ||
| Anatomic Pathology Physician | 207ZP0101X | NC | ||
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | NC | Primary |
Addresses
Primary practice location
100 N Bridge St
Suite C
Wilkesboro, NC 28697-2488
Mailing address
507 N Lindsay St
High Point, NC 27262-4303
Phone (336) 883-0029
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7901101 | Medicaid | NC | |
| 89011F1 | Medicaid | NC | |
| 5907644 | Medicaid | NC | |
| 3409940 | Medicaid | NC |
Other names 1
- Bethany Pathology Lab
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041013000729 | NC | Part B Supplier - Clinic/Group Practice | 4486614575 |
Receives reassigned benefits from 88 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: High Point, NC; Winston Salem, NC; North Wilkesboro, NC; Mount Airy, NC; Kernersville, NC; Jamestown, NC; Greensboro, NC |
Other NPIs on the same Medicare enrollment 16
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Pain Medicine (Anesthesiology) Physician
- North Wilkesboro, NC
- NPI 1508341736
O20041013000729
-
dba Bethany Medical Pain Clinic
- Internal Medicine Physician
- Winston Salem, NC
- NPI 1528554631
O20041013000729
-
- Anatomic Pathology & Clinical Pathology Physician
- Kernersville, NC
- NPI 1619398997
O20041013000729
National Provider Directory
National Provider Directory- Part of
- Bethany Medical Ctr PA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383177600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1760313600000",
"number": "1992133870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 N LINDSAY ST",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272624303",
"telephone_number": "336-883-0029",
"fax_number": "336-899-2188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N BRIDGE ST",
"address_2": "SUITE C",
"city": "WILKESBORO",
"state": "NC",
"postal_code": "286972488",
"telephone_number": "336-883-0029",
"fax_number": "336-899-2188"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BETHANY MEDICAL CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BETHANY MEDICAL CENTER",
"enumeration_date": "2013-10-31",
"last_updated": "2025-10-13",
"certification_date": "2025-10-13",
"status": "A",
"authorized_official_last_name": "WOMBLE",
"authorized_official_first_name": "MANDY",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "336-883-0029"
},
"taxonomies": [
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "NC",
"license": null,
"primary": false
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "NC",
"license": null,
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NC",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7901101",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89011F1",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5907644",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3409940",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bethany Pathology Lab",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Wilkesboro, NC
- Barium Springs Home for Children (Children's Hope Alliance)
- Barium Springs Home for Children Kulynych Cottage
- Daniel Barnette, MD
- Leshea Barnette
- Kimberley Bennett, NUTRITIONIST
- Lynda Black, PHD, LPC
- Blue Ridge Speech, LLC.
- Allison Brame, M.S., OTR/L
- Deborah Sue Bufkin, PTA
- James Ethan Burgess, PT, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.