Provider Demographics
NPI:1124265236
Name:WAKE FOREST HEALTH NETWORK LLC
Entity type:Organization
Organization Name:WAKE FOREST HEALTH NETWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GREVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-716-1331
Mailing Address - Street 1:114 KINDERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BERMUDA RUN
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7302
Mailing Address - Country:US
Mailing Address - Phone:336-998-9742
Mailing Address - Fax:336-998-9410
Practice Address - Street 1:114 KINDERTON BLVD
Practice Address - Street 2:
Practice Address - City:BERMUDA RUN
Practice Address - State:NC
Practice Address - Zip Code:27006-7302
Practice Address - Country:US
Practice Address - Phone:336-998-9742
Practice Address - Fax:336-998-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCB8658OtherRR MEDICARE
NCCC4241OtherRR MEDICARE
NCCD6614OtherRR MEDICARE
NC5912346Medicaid
NCCC4243OtherRR MEDICARE