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NPI Code Detail

MEDICARE: WAKE FOREST HEALTH NETWORK LLC

MEDICARE: WAKE FOREST HEALTH NETWORK LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DP8978OTHERNCRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730416801
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAKE FOREST HEALTH NETWORK LLC
Provider Business Mailing Address
First Line : 4431 US HIGHWAY 220 N
Second Line :
City : SUMMERFIELD
State : NC
Zip : 27358-9411
Country : US
Telephone Number : 336-643-7711
Fax Number : 336-643-3047
Provider Business Practice Location Address
First Line : 4431 HWY 220 N
Second Line :
City : SUMMERFIELD
State : NC
Zip : 27358-9411
Country : US
Telephone Number : 336-643-7711
Fax Number : 336-643-3047
Authorized Official
Title or Position : SR VP CLINICAL OPERATIONS
Name : CRAIG MICHAEL GREVEN
Credential : MD
Telephone Number : 336-716-1331
Provider Enumeration Date : 11/11/2009
Last Update Date : 09/25/2025

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Practice Location Address:
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1548344450 — DR. FRED HENRY WILSON MD
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SUMMERFIELD, NC
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1083798904 — DR. BRENT ALAN BURNETT MD
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1740305101 — GEORGE DAVID EDENFIELD SR. PAC
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1316112923 — MAUREEN CONAGHAN GOLDEN FNP
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Directions to “WAKE FOREST HEALTH NETWORK LLC ” Practice Location

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