Basic Information
| Provider Information | |||||||||
| NPI: | 1740918044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST JOSEPH HEALTH PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 GLADE PARK RD | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275188683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197060563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 NEW WAVERLY PL STE 203 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198587020 | ||||||||
| FaxNumber: | 9198595695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2022 | ||||||||
| LastUpdateDate: | 08/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | WADIE | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SURGEON/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9197060563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.