Provider Demographics
NPI:1639058662
Name:WAKE ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:WAKE ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE IMPLEMENTATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HEWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-341-3623
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-341-3544
Mailing Address - Fax:919-341-3553
Practice Address - Street 1:929 KILDAIRE FARM RD STE 105
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3922
Practice Address - Country:US
Practice Address - Phone:919-341-3544
Practice Address - Fax:919-341-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical