Provider Demographics
NPI:1235192725
Name:CAPE FEAR CARDIOVASCULAR & THORACIC SURGERY PA
Entity Type:Organization
Organization Name:CAPE FEAR CARDIOVASCULAR & THORACIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WELSHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-672-0350
Mailing Address - Street 1:PO BOX 61056
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715-1056
Mailing Address - Country:US
Mailing Address - Phone:919-544-6318
Mailing Address - Fax:919-544-6336
Practice Address - Street 1:2153 VALLEYGATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3667
Practice Address - Country:US
Practice Address - Phone:910-672-0350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC690189QMedicaid
NC2343954Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER