Provider Demographics
NPI:1265430342
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: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 1:3320 WAKE FOREST RD
Mailing Address - Street 2:204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7300
Mailing Address - Country:US
Mailing Address - Phone:919-790-5391
Mailing Address - Fax:919-790-6823
Practice Address - Street 1:3320 WAKE FOREST RD
Practice Address - Street 2:204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7300
Practice Address - Country:US
Practice Address - Phone:919-790-5391
Practice Address - Fax:919-790-6823
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
NC89-016J2Medicaid
NC230473Medicare ID - Type Unspecified