Provider Demographics
NPI:1386778926
Name:NORTH CAROLINA BAPTIST HOSPITAL
Entity type:Organization
Organization Name:NORTH CAROLINA BAPTIST HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND COO OF HEALTH SYSTEM
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-716-3005
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-0027
Mailing Address - Fax:336-716-6705
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1191
Practice Address - Country:US
Practice Address - Phone:336-716-3539
Practice Address - Fax:336-716-3153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CAROLINA BAPTIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH00112080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906592Medicaid
NC5906592Medicaid