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DSH340047AN NORTH CAROLINA BAPTIST HOSPITAL (Active)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
Clemmons - Peds GI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047AN
Medicare Provider Number
340047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/15/2013
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
North Carolina Baptist Hospital
Michael Thomas Waid, Sr Vice President - Health System Operations and Integration
(336) 716-0433
Primary Contact
North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426
Addresses
Street Address
2311 Lewisville-Clemmons Rd
Clemmons, NC 27012
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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