Provider Demographics
NPI:1295850923
Name:WAKE FOREST HEALTH NETWORK LLC
Entity type:Organization
Organization Name:WAKE FOREST HEALTH NETWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GREVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-716-1331
Mailing Address - Street 1:1814 WESTCHESTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7369
Mailing Address - Country:US
Mailing Address - Phone:336-802-2105
Mailing Address - Fax:336-802-2106
Practice Address - Street 1:1814 WESTCHESTER DR STE 101
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7369
Practice Address - Country:US
Practice Address - Phone:336-802-2105
Practice Address - Fax:336-802-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7640710OtherAETNA
50146OtherMEDCOST
NC0247NOtherBCBS
NCCD6614OtherRR MEDICARE
NC5913176Medicaid
NCCB8658OtherRR MEDICARE
NCCC4242OtherRR MEDICARE
NCCC5472OtherRR MEDICARE
NCCF9200OtherRR MEDICARE
NC890247NMedicaid
NCD266OtherPARTNERS MEDICARE CHOICE
NCCC4243OtherRR MEDICARE
NCCC6608OtherRR MEDICARE
269374OtherMAMSI
NCCC4241OtherRRMC
50146OtherMEDCOST
NC5913176Medicaid
50146OtherMEDCOST