1972579837 NPI number — WAKEMED

Table of content: (NPI 1972579837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972579837 NPI number — WAKEMED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAKEMED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WAKEMED RALEIGH CAMPUS
Provider Other Organization Name Type Code:
3
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:
1972579837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 NEW BERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27610-1295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-350-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 NEW BERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27610-1295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-350-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARRICO
Authorized Official First Name:
RICK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP, FINANCE & CFO
Authorized Official Telephone Number:
919-350-8000

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H0199 , 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: 011 . This is a "CHAMPUS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3400069A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00356 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 00361 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3400069 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003 . This is a "CHAMPUS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3400069F , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009 . This is a "CHAMPUS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3400069E , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002C9 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".