NPIMap

Organization Active NPI

Wake Teen Medical Services Inc.

  • Health Service Clinic/Center
  • Raleigh, NC
National Provider Identifier
1457319576
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
WAKE TEEN MEDICAL SERVICES INC.
Practice address
505 Oberlin Rd
Suite 204
Raleigh, NC 27605-1397
Phone
(909) 828-0035
Fax
(909) 828-0355
NPI assigned
May 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Joyce Wood
Title
President, Executive Director
Phone
(919) 828-0038

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

505 Oberlin Rd
Suite 204
Raleigh, NC 27605-1397

Mailing address

505 Oberlin Rd
Suite 204
Raleigh, NC 27605-1397
Phone (909) 828-0035

Other identifiers 2

IdentifierTypeStateIssuer
8902730MedicaidNC
02730OtherNCNC BCBS GROUP NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Wake Teen Medical Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457319576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 OBERLIN RD",
            "address_2": "SUITE 204",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276051397",
            "telephone_number": "909-828-0035",
            "fax_number": "909-828-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 OBERLIN RD",
            "address_2": "SUITE 204",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276051397",
            "telephone_number": "909-828-0035",
            "fax_number": "909-828-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE TEEN MEDICAL SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "PRESIDENT, EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-828-0038",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902730",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BCBS GROUP NUMBER",
            "identifier": "02730",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.