MEDICARE: WAKE FOREST URGENT CARE, PLLC

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
1	261Q00000X	Clinic/Center	24323	NC

General Provider Information

NPI Number	:	1326001850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE FOREST URGENT CARE, PLLC

Provider Business Mailing Address
First Line	:	2115 S MAIN ST STE A
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5011
Country	:	US
Telephone Number	:	919-570-2000
Fax Number	:	919-570-2001

Provider Business Practice Location Address
First Line	:	2115 S MAIN ST
Second Line	:	SUITE A
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5011
Country	:	US
Telephone Number	:	919-570-2000
Fax Number	:	919-570-2001

Authorized Official
Title or Position	:	MD/MANAGER
Name	:	WILLIAM GILMER CLARK
Credential	:	M.D.
Telephone Number	:	919-570-2000

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	06/18/2008

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