| Warren Stacks Md | |
|
1400 Westgate Center Dr Ste 140 Winston Salem NC 27103-3104 | |
| (336) 659-9440 | |
| (336) 659-9845 |
| Full Name | Warren Stacks Md |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 Westgate Center Dr Ste 140, Winston Salem, North Carolina |
| Authorized Official Name and Position | Warren Stacks (OWNER) |
| Authorized Official Contact | 3366599440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Warren Stacks Md Po Box 30249 Winston Salem NC 27130-0249 Ph: (336) 659-9440 | Warren Stacks Md 1400 Westgate Center Dr Ste 140 Winston Salem NC 27103-3104 Ph: (336) 659-9440 |
| NPI Number | 1376714816 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 04/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376714816 | NPI | - | NPPES |
| 79116 | Other | NC | BCBS |
| 8979116 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9401498 (North Carolina) | Primary |
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