| Wake Primary Care, Pllc | |
|
400 Ashville Ave Suite 315 Cary NC 27518-6134 | |
| (919) 803-3316 | |
| (919) 803-3354 |
| Full Name | Wake Primary Care, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 400 Ashville Ave, Cary, North Carolina |
| Authorized Official Name and Position | John Smith (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 9193426842 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Primary Care, Pllc 408 Cole Crest Ct Cary NC 27513-8374 Ph: (919) 803-3316 | Wake Primary Care, Pllc 400 Ashville Ave Suite 315 Cary NC 27518-6134 Ph: (919) 803-3316 |
| NPI Number | 1629405550 |
|---|---|
| Provider Enumeration Date | 10/10/2013 |
| Last Update Date | 10/10/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629405550 | NPI | - | NPPES |
| 5917977 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2011-01123 (North Carolina) | Primary |
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