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Contact Information

WAKEMED SPECIALISTS GROUP, LLC
104 MEDSPRING DR
CLAYTON, NC27520-9687
 Phone: 919-235-6535
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Pulmonology

2080P0214X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for WAKEMED SPECIALISTS GROUP, LLC

NPI Number 1407409543
LBN Legal business name WAKEMED SPECIALISTS GROUP, LLC
Authorized official MARIA JAYOUSSI - (EXECUTIVE DIRECTOR OF FINANCE)
Entity Organization
Organization subpart 1 No
Enumeration date 07/18/2019
Last updated 02/06/2020 - About 6 years ago
Identifiers
NC Medicaid 1407409543
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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