Provider Demographics
NPI:1437157518
Name:WAKE HEART AND VASCULAR ASSOCIATES P.A.
Entity Type:Organization
Organization Name:WAKE HEART AND VASCULAR ASSOCIATES P.A.
Other - Org Name:SMITHFIELD HEART AND VASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-420-1342
Mailing Address - Street 1:910 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4751
Mailing Address - Country:US
Mailing Address - Phone:919-989-7909
Mailing Address - Fax:919-989-3147
Practice Address - Street 1:910 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4751
Practice Address - Country:US
Practice Address - Phone:919-989-7909
Practice Address - Fax:919-989-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-016JWMedicaid
NC89-016JWMedicaid