Provider Demographics
NPI:1326404781
Name:STEDMAN-WADE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:STEDMAN-WADE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-6694
Mailing Address - Street 1:7118 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-9749
Mailing Address - Country:US
Mailing Address - Phone:910-483-6694
Mailing Address - Fax:
Practice Address - Street 1:7118 MAIN ST
Practice Address - Street 2:
Practice Address - City:WADE
Practice Address - State:NC
Practice Address - Zip Code:28395-9749
Practice Address - Country:US
Practice Address - Phone:910-483-6694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225782261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCM335AMedicare UPIN