Provider Demographics
NPI:1578534871
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:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAMELIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:910-483-2853
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:HWY 301 NORTH
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-9749
Mailing Address - Country:US
Mailing Address - Phone:910-483-2853
Mailing Address - Fax:910-483-2215
Practice Address - Street 1:HWY 301 NORTH
Practice Address - Street 2:7118 MAIN STREET
Practice Address - City:WADE
Practice Address - State:NC
Practice Address - Zip Code:28395-9749
Practice Address - Country:US
Practice Address - Phone:910-483-2853
Practice Address - Fax:910-483-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
02972OtherBCBS
NC89132103Medicaid
NC344511DMedicaid
NC344511AMedicaid
NC344511CMedicaid
NC344511DMedicaid
NC344511CMedicaid
NC2804046Medicare PIN