Basic Information
| Provider Information | |||||||||
| NPI: | 1326001850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAKE FOREST URGENT CARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2115 S MAIN ST STE A | ||||||||
| Address2: | |||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275875011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195702000 | ||||||||
| FaxNumber: | 9195702001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2115 S MAIN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275875011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195702000 | ||||||||
| FaxNumber: | 9195702001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | GILMER | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9195702000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 24323 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.