Provider Demographics
NPI:1225124118
Name:WAKE URGENT CARE & FAMILY CLINIC INC.
Entity Type:Organization
Organization Name:WAKE URGENT CARE & FAMILY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PRACTICE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CATTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-550-0821
Mailing Address - Street 1:935 SHOTWELL RD.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5597
Mailing Address - Country:US
Mailing Address - Phone:919-550-0821
Mailing Address - Fax:919-550-0821
Practice Address - Street 1:5156 NC HWY 42 WEST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8417
Practice Address - Country:US
Practice Address - Phone:919-329-5000
Practice Address - Fax:919-329-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015RJOtherBCBS OF NC GROUP NUMBER
7620733OtherAETNA
NC89015RJMedicaid
NC015RJOtherBCBS OF NC GROUP NUMBER