| Atrium Health Wake Forest Baptist Neurology - Triad | |
|
145 Kimel Park Dr Suite 100 Winston Salem NC 27103-6983 | |
| (336) 768-6347 | |
| (336) 760-9393 |
| Full Name | Atrium Health Wake Forest Baptist Neurology - Triad |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 145 Kimel Park Dr, Winston Salem, North Carolina |
| Authorized Official Name and Position | Russell Mars Howerton (SR VP NETWORK PHYS & HS CMO) |
| Authorized Official Contact | 3367161331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Atrium Health Wake Forest Baptist Neurology - Triad 100 Kimel Forest Dr Winston Salem NC 27103-6074 Ph: (336) 716-1331 | Atrium Health Wake Forest Baptist Neurology - Triad 145 Kimel Park Dr Suite 100 Winston Salem NC 27103-6983 Ph: (336) 768-6347 |
| NPI Number | 1700918877 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 11/29/2023 |
| Certification Date | 11/29/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700918877 | NPI | - | NPPES |
| CC4241 | Other | NC | RRMC |
| CC4242 | Other | NC | RR MEDICARE |
| CC5472 | Other | NC | RR MEDICARE |
| D266 | Other | NC | PARTNERS MEDICARE CHOICE |
| 016UW | Other | NC | BCBS |
| CC4243 | Other | NC | RR MEDICARE |
| CF9200 | Other | NC | RR MEDICARE |
| 269374 | Other | MAMSI | |
| B0433 | Other | MEDCOST | |
| CB8658 | Other | NC | RRMC |
| CD6614 | Other | NC | RR MEDICARE |
| 89016UW | Medicaid | NC | |
| CC6608 | Other | NC | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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