Provider Demographics
NPI:1477104719
Name:WAKE FOREST EMERGENCY PROVIDERS
Entity Type:Organization
Organization Name:WAKE FOREST EMERGENCY PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMERGENCY MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-716-5599
Mailing Address - Street 1:PO BOX 896244
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6244
Mailing Address - Country:US
Mailing Address - Phone:919-383-0328
Mailing Address - Fax:
Practice Address - Street 1:2005 PISGAH CHURCH RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3309
Practice Address - Country:US
Practice Address - Phone:336-701-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty