Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WakeMed Urgent Care
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
222 ASHVILLE AVE STE 10, CARY, NC 27518-6130
(919) 859-1136
(919) 859-4240
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013297365
—
NC
01
—
7108950007
DME PTAN
NC
Enumeration date
07/14/2014
Last updated
05/03/2019
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