Provider Demographics
NPI:1114993086
Name:WAKEMED
Entity Type:Organization
Organization Name:WAKEMED
Other - Org Name:WAKEMED CARY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, HEALTH INFO & UTIL MGMT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-350-8344
Mailing Address - Street 1:1900 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6616
Mailing Address - Country:US
Mailing Address - Phone:919-350-2355
Mailing Address - Fax:919-350-2459
Practice Address - Street 1:1900 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6616
Practice Address - Country:US
Practice Address - Phone:919-350-2355
Practice Address - Fax:919-350-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0276282N00000X
NC053713336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
2070401OtherPK
NC3400173Medicaid
NC3400173Medicaid
NC00076OtherBCBS PROVIDER NUMBER
NC3400173Medicaid