Healthcare Provider Details

I. General information

NPI: 1134035850
Provider Name (Legal Business Name): WAKE FOREST HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CHATHAM MEDICAL PARK
ELKIN NC
28621-2484
US

IV. Provider business mailing address

800 CHATHAM MEDICAL PARK
ELKIN NC
28621-2484
US

V. Phone/Fax

Practice location:
  • Phone: 336-941-7247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CRAIG MICHAEL GREVEN
Title or Position: SR VP NETWORK PHYS & HSCMO
Credential: MD
Phone: 336-716-1331