Provider Demographics
NPI:1740249465
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:MD
Authorized Official - Phone:336-716-1331
Mailing Address - Street 1:770 HIGHLAND OAKS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7105
Mailing Address - Country:US
Mailing Address - Phone:336-765-5250
Mailing Address - Fax:336-659-0953
Practice Address - Street 1:770 HIGHLAND OAKS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7105
Practice Address - Country:US
Practice Address - Phone:336-765-5250
Practice Address - Fax:336-659-0953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC4243OtherRR MEDICARE
NC5905780Medicaid
NCCB8658OtherRR MEDICARE
NCCD6614OtherRR MEDICARE
NCCC4241OtherRR MEDICARE
NCCC4241OtherRR MEDICARE