Provider Demographics
NPI:1912639808
Name:STEDMAN - WADE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:STEDMAN - WADE HEALTH SERVICES, INC
Other - Org Name:WADE FAMILY MEDICAL CENTER ADULT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:MELVA
Authorized Official - Middle Name:LEONOR
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-6694
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-0449
Mailing Address - Country:US
Mailing Address - Phone:910-483-6694
Mailing Address - Fax:910-483-2215
Practice Address - Street 1:1235 RAMSEY ST STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4401
Practice Address - Country:US
Practice Address - Phone:910-433-3770
Practice Address - Fax:910-307-3951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEDMAN - WADE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-29
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty