Healthcare Provider Details

I. General information

NPI: 1104959055
Provider Name (Legal Business Name): WAKE FOREST HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 N UNIVERSITY PARKWAY
HIGH POINT NC
27262-7612
US

IV. Provider business mailing address

1565 N UNIVERSITY PKWY
HIGH POINT NC
27262-7613
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2020
  • Fax: 336-802-2021
Mailing address:
  • Phone: 336-802-2020
  • Fax: 336-802-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CRAIG MICHAEL GREVEN
Title or Position: SR VP CLINICAL OPERATIONS
Credential: MD
Phone: 336-716-1331