WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS (NPI# 1942489695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942489695 |
| Entity Type | Organization |
| Organization Name | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS |
| Other Organization Name | CLUB HAVEN FAMILY PRACTICE |
| Practice Address |
2801 Lyndhurst Ave Winston Salem NC 27103-4109 |
| Practice Telephone | 3367689575 |
| Practice Fax Number | 3367741737 |
| Mailing Telephone | 3367689575 |
| Mailing Fax Number | 3367741737 |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2008-04-10 |
| Authorized Official Name | LEWIS S THORP III (PRESIDENT/CEO) |
| Authorized Official Telephone | 3367213900 |
| Is Organization Subpart | Y |
| Parent Organization Name | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | MEDICARE GROUP NUMBER | 2317728X | 01 |
| NC | 5908389 | 05 |
| Other Name | Type Code |
|---|---|
| Club Haven Family Practice | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871780148 | Wake Forest University Baptist Medical Center Community Physicians | Family Medicine | 5391 Us Highway 158, Advance, NC 27006-6907 | 2007-10-01 |
| 1871797688 | Wake Forest University Baptist Medical Center Community Physicians | Family Medicine | 5175 Old Clemmons School Road, Clemmons, NC 27012 | 2007-06-14 |
| 1972596211 | Wake Forest University Baptist Medical Center Community Physicians | Family Medicine | 167 Moore Rd, King, NC 27021-8770 | 2005-08-23 |
| 1477546620 | Wake Forest University Baptist Medical Center Community Physicians | Family Medicine | 910 Worth St, Foothills Primary Care, Mount Airy, NC 27030-4458 | 2005-08-23 |
| 1417940636 | Wake Forest University Baptist Medical Center Community Physicians | Family Medicine | 509 Brookdale Dr, Young Family Practice, Statesville, NC 28677-4107 | 2005-08-23 |
| 1013900356 | Wake Forest University Baptist Medical Center Community Physicians | Internal Medicine | 1916 West Park Dr, North Wilkesboro, NC 28659-3563 | 2005-08-23 |
| 1568455707 | Wake Forest University Baptist Medical Center Community Physicians | Pediatrics | 113 Marketplace Drive, Mocksville, NC 27028 | 2005-08-23 |
| 1316930654 | Wake Forest University Baptist Medical Center Community Physicians | Family Medicine | 7990 North Point Blvd, Winston Salem, NC 27106-3259 | 2005-08-23 |
| 1912111766 | Wake Forest University Baptist Medical Center Community Physicians | Internal Medicine | 1916 W Park Dr, North Wilkesboro, NC 28659-3563 | 2007-05-10 |
| 1588657605 | Wake Forest University Baptist Medical Center Community Physicians | Family Medicine | 304 Mountain View Rd, King, NC 27021-8768 | 2005-08-24 |
| Street Address |
2801 LYNDHURST AVE |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-4109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922323948 | Club Haven Family Practice Pa | Family Medicine | 2801 Lyndhurst Ave, Winston Salem, NC 27103-4109 | 2010-04-01 |
| 1164480455 | Antonia Rosario Tettamanti | Family Medicine | 2801 Lyndhurst Ave, Winston Salem, NC 27103-4109 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962048512 | Novant Medical Group, Inc | Family Medicine | 1400 Westgate Ctr Dr Ste 110, Winston Salem, NC 27103-3104 | 2019-11-19 |
| 1669026456 | Brandon Chase Barnette | Family Medicine | 1825 Denise Ln, Winston Salem, NC 27127-8850 | 2019-07-30 |
| 1649747999 | Darryl Landis | Family Medicine | 480 Stonegate Ln, Winston Salem, NC 27104-1825 | 2018-10-25 |
| 1063918670 | Cms Med Health and Wellness Pllc | Family Medicine | 3878 Oxford Station Way, Winston Salem, NC 27103-1340 | 2018-04-03 |
| 1083069082 | Michael Merz | Family Medicine | Wake Forest Family Medicine Residency, Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2016-04-27 |
| 1225475023 | Novant Medical Group Inc | Family Medicine | 10479 N Nc Highway 109, 107a, Winston Salem, NC 27107-9643 | 2013-06-03 |
| 1598028987 | Urgent Cares of America North Carolina Inc. | Family Medicine | 310 S Stratford Rd, Winston Salem, NC 27103-1820 | 2012-06-20 |
| 1518224617 | Daniel Lewis Myers | Family Medicine | 10479 N Nc Highway 109 Ste 107a, Winston Salem, NC 27107-9884 | 2012-04-13 |
| 1982989828 | Urgent Cares of America North Carolina Inc | Family Medicine | 4937 Old Country Club Rd., Winston Salem, NC 27104-5068 | 2011-10-11 |
| 1558657403 | Laura Bartels Torres | Family Medicine | 50 Miller St Ste G, Winston Salem, NC 27104 | 2011-06-20 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
Please comment or provide details below to improve the information on WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.