Healthcare Provider Details

I. General information

NPI: 1578534871
Provider Name (Legal Business Name): STEDMAN-WADE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7118 MAIN ST
WADE NC
28395-9749
US

IV. Provider business mailing address

PO BOX 449
WADE NC
28395-0449
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-6694
  • Fax: 910-483-2215
Mailing address:
  • Phone: 910-483-2853
  • Fax: 910-483-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: PAMELIA R HORTON
Title or Position: DIRECTOR OF OPERATIONS
Credential: CPC
Phone: 910-483-2853