Provider Demographics
NPI:1326001850
Name:WAKE FOREST URGENT CARE, PLLC
Entity Type:Organization
Organization Name:WAKE FOREST URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GILMER
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-570-2000
Mailing Address - Street 1:2115 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5011
Mailing Address - Country:US
Mailing Address - Phone:919-570-2000
Mailing Address - Fax:919-570-2001
Practice Address - Street 1:2115 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5011
Practice Address - Country:US
Practice Address - Phone:919-570-2000
Practice Address - Fax:919-570-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24323261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC83247Medicare UPIN