NPIMap

Organization Active NPI

Stedman-Wade Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Wade, NC
National Provider Identifier
1578534871
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STEDMAN-WADE HEALTH SERVICES, INC.
Practice address
7118 Main St
Wade, NC 28395-9749
Phone
(910) 483-6694
Fax
(910) 483-2215
NPI assigned
Jan 27, 2006
Last updated
May 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Pamelia R Horton, CPC
Title
Director of Operations
Phone
(910) 483-2853

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Point of Service 305S00000X

Addresses

Primary practice location

7118 Main St
Wade, NC 28395-9749

Mailing address

PO Box 449
Wade, NC 28395-0449
Phone (910) 483-2853

Other identifiers 5

IdentifierTypeStateIssuer
344511DMedicaidNC
89132103MedicaidNC
344511CMedicaidNC
344511AMedicaidNC
02972OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080312000140 NC Part A Provider - Federally Qualified Health Center (FQHC) 0042205189 Practice locations: Wade, NC
O20110622000171 NC Part B Supplier - Clinic/Group Practice 0042205189 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fayetteville, NC; Wade, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578534871. Details of each certification follow.

Federally qualified health center certification: CCN 341824

Legal name
STEDMAN-WADE HEALTH SERVICES, INC.
Doing business as
WADE FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1992
Last certification
Jun 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 3, 1978 in NC
Enrollment address
7118 Main St
Wade, NC 28395-9749

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0245605Wade Family Medical Center7118 Main St, Wade, NC 28395Certificate of waiverOct 11, 2027

National Provider Directory

National Provider Directory

Locations

1235 Ramsey St
Fl 2
Fayetteville, NC 28301
Phone (910) 433-3777

2313 Murchison Rd
Ste B
Fayetteville, NC 28301

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lynetta Geddie Individual Corporate Director Mar 14, 2008
Melva Z Jackson Individual Corporate Director Jun 1, 2021
Operational/Managerial Control Feb 1, 2012
Hazel Stubbs Individual Corporate Director Mar 14, 2008
Hattie Lassiter Individual Corporate Director Feb 18, 2008
Margaret J Covington Individual Corporate Director Mar 14, 2008

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1578534871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 449",
            "city": "WADE",
            "state": "NC",
            "postal_code": "283950449",
            "telephone_number": "910-483-2853",
            "fax_number": "910-483-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7118 MAIN ST",
            "city": "WADE",
            "state": "NC",
            "postal_code": "283959749",
            "telephone_number": "910-483-6694",
            "fax_number": "910-483-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEDMAN-WADE HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "HORTON",
        "authorized_official_first_name": "PAMELIA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "910-483-2853",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344511D",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89132103",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344511C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344511A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02972",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wade, NC

Sources for this page

Verify at the official NPI Registry.