Provider Demographics
NPI:1891012324
Name:WAKE HEART AND VASCULAR ASSOCIATES P.A.
Entity Type:Organization
Organization Name:WAKE HEART AND VASCULAR ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
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 1:1966 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9336
Mailing Address - Country:US
Mailing Address - Phone:919-570-1252
Mailing Address - Fax:919-556-9985
Practice Address - Street 1:1966 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9336
Practice Address - Country:US
Practice Address - Phone:919-570-1252
Practice Address - Fax:919-556-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty