| Wake Forest Health Network Llc | |
|
4431 Hwy 220 N Summerfield NC 27358-9411 | |
| (336) 643-7711 | |
| (336) 643-3047 |
| Full Name | Wake Forest Health Network Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4431 Hwy 220 N, Summerfield, North Carolina |
| Authorized Official Name and Position | Russell Mars Howerton (SR VP NETWORK PHYS & HS CMO) |
| Authorized Official Contact | 3367161331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Forest Health Network Llc 100 Kimel Forest Dr Winston Salem NC 27103-6074 Ph: (336) 716-1331 | Wake Forest Health Network Llc 4431 Hwy 220 N Summerfield NC 27358-9411 Ph: (336) 643-7711 |
| NPI Number | 1730416801 |
|---|---|
| Provider Enumeration Date | 11/11/2009 |
| Last Update Date | 11/08/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730416801 | NPI | - | NPPES |
| 5913764 | Medicaid | NC | |
| DP8978 | Other | NC | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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