Wake Specialty Physicians LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

WAKE SPECIALTY PHYSICIANS LLC

Practice address

2001 S Main St Ste 200
Wake Forest, NC 27587-1652

Phone

(919) 350-0365

Fax

(919) 235-1307

NPI assigned

Jan 25, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shondra Lynn Brink

Title

VP, WPP Operations

Phone

(919) 350-6045

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• WakeMed MyCare 365 Primary & Urgent Care Wake Forest Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Wakemed

  • Home Health Agency
  • Raleigh, NC
  • NPI 1467435842

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1245820091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "919-350-0552",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S MAIN ST STE 200",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275871652",
            "telephone_number": "919-350-0365",
            "fax_number": "919-235-1307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "BRINK",
        "authorized_official_first_name": "SHONDRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP, WPP OPERATIONS",
        "authorized_official_telephone_number": "919-350-6045"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346852407",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed MyCare 365 Primary & Urgent Care Wake Forest",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WakeMed MyCare 365 Primary & Urgent Care Wake Forest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wake Forest Urgent Care, PLLC
• Wake Heart and Vascular Associates P.a.
• Wake Skin Cancer Center, PA
• Wake Specialty Physicians
• Wake Specialty Physicians LLC
• Wake Specialty Physicians LLC
• Wakefield Eye Care, OD PLLC
• Wakefield Medical Inc
• Wakefield Medical Specialty Services Inc
• Wakemed Specialists Group LLC

• Durable Medical Equipment & Medical Supplies in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Durable Medical Equipment & Medical Supplies in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.