Healthcare Provider Details

I. General information

NPI: 1043127434
Provider Name (Legal Business Name): STEDMAN WADE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 CLINTON RD
STEDMAN NC
28391-8846
US

IV. Provider business mailing address

PO BOX 368
STEDMAN NC
28391-0368
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-3150
  • Fax:
Mailing address:
  • Phone: 910-483-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JILL WILLIAMS
Title or Position: CREDENTIALING
Credential:
Phone: 910-483-6694