NPIMap

Organization Active NPI

Stedman-Wade Health Services, Inc.

Doing business as Wade Family Medical Center Downtown

  • Federally Qualified Health Center (FQHC)
  • Fayetteville, NC
National Provider Identifier
1609186790
Registry record updated May 22, 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.
Doing business as
Wade Family Medical Center Downtown
Practice address
2313 Murchison Rd
Fayetteville, NC 28301-3517
Phone
(910) 483-6694
NPI assigned
Oct 7, 2010
Last updated
May 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Authorized official

Name
Margaret Covington
Title
Ceo
Phone
(910) 483-6694

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

2313 Murchison Rd
Fayetteville, NC 28301-3517

Mailing address

2313 Murchison Rd
Fayetteville, NC 28301-3517
Phone (910) 483-6694

Other names 1

  • Wade Family Medical Center Downtown Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110622000171 NC Part B Supplier - Clinic/Group Practice 0042205189 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
Practice locations: Fayetteville, NC; Wade, NC
O20120719000421 NC Part A Provider - Federally Qualified Health Center (FQHC) 0042205189 Practice locations: Fayetteville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609186790. Details of each certification follow.

Federally qualified health center certification: CCN 341980

Legal name
STEDMAN-WADE HEALTH SERVICES, INC.
Doing business as
WADE FAMILY MEDICAL CENTER DOWNTOWN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 23, 2012
Last certification
Jul 23, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 3, 1978 in NC
Enrollment address
2313 Murchison Rd
Fayetteville, NC 28301-3517

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
34D2212400Wade Family Medical Center Downtown2313 Murchison Road, Fayetteville, NC 28301Certificate of waiverOct 11, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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 OfficerBoard President Jul 1, 2000
Melva Z Jackson Individual W-2 Managing Employee Feb 26, 1996
Margaret J Covington Individual 5% Or Greater Direct Ownership Interest Mar 19, 1994
Corporate Officer Mar 19, 1994
Corporate Director Mar 19, 1994
Operational/Managerial ControlCeo Mar 19, 1994

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1609186790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2313 MURCHISON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013517",
            "telephone_number": "910-483-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2313 MURCHISON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013517",
            "telephone_number": "910-483-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEDMAN-WADE HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-07",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "COVINGTON",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-483-6694"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wade Family Medical Center Downtown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.