Organization
WAKEMED
Active
Parent organization
WAKEMED
Other names
WakeMed Fuquary Varina Outpatient and SNF
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAKEMED
Authorized official
MR. MICHAEL D DEVAUGHN CPA (SR VP OF FINANCE AND CFO)
(919) 350-8000
Entity
Organization
Contact information
Practice address
400 W RANSOM ST, FUQUAY VARINA, NC 27526-2434
(919) 350-4600
Mailing address
400 W RANSOM ST, FUQUAY VARINA, NC 27526-2434
(919) 350-4600
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
H0276
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0093C
BLUE CROSS
NC
05
—
3405308
—
NC
05
—
3496096
—
NC
Enumeration date
02/28/2006
Last updated
03/22/2010
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