1740215532 NPI number — STEPHEN B WADE MD

Table of content: STEPHEN B WADE MD (NPI 1740215532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740215532 NPI number — STEPHEN B WADE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WADE
Provider First Name:
STEPHEN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740215532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27102-0344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-716-2255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5904590 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190074 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810008047 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2058779 . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7318833 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 808510 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142R9 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10406862 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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