WAKE SPECIALTY PHYSICIANS LLC NPI 1497204143

NPI Information

NPI: 1497204143
Provider Name: WAKE SPECIALTY PHYSICIANS LLC

Doing Business As: WAKEMED PHYSICIAN PRACTICES GROUP HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
2820 KIDD RD
RALEIGH, NC
ZIP 27610
Phone: (919) 350-2800
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WAKE SPECIALTY PHYSICIANS LLC is an intermediate care facility mentally retarded in Raleigh, NC. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. WAKE SPECIALTY PHYSICIANS LLC NPI is 1497204143. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Wakemed Physician Practices Group Home.

The provider's business location address is:

2820 KIDD RD
RALEIGH, NC
ZIP 27610-842
Phone: (919) 350-2800
Fax: (919) 350-8147

The provider's authorized official is Maria Jayoussi .
The authorized official title is Executive Director Of Finance and has the following contact phone number (919) 350-6089.

The enumeration date for this NPI number is 9/22/2016 and was last updated on 3/22/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License State	Primary
1	207Q00000X	Family Medicine		No
2	208000000X	Pediatrics		No
3	315P00000X	Intermediate Care Facility, Intellectual Disabilities	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1942440375	MEDICAID	NORTH CAROLINA
2	2347332	MEDICARE PIN	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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