Organization
WAKEMED SPECIALISTS GROUP LLC
Active
Other names
WakeMed Wake Orthopaedics
Organization subpart
No
Provider details
NPI number
Authorized official
SHONDRA LYNN BRINK (VP, WPP)
(919) 350-6045
Entity
Organization
Contact information
Practice address
505 OBERLIN RD, RALEIGH, NC 27605-1345
(919) 882-6578
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417512690
—
NC
01
—
J143
MEDICARE
NC
Enumeration date
11/12/2021
Last updated
11/12/2021
Update your record
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