Provider Demographics
NPI:1780053082
Name:WENDOVER PRIMARY CARE CLINIC, PLLC
Entity type:Organization
Organization Name:WENDOVER PRIMARY CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:CHIKE
Authorized Official - Last Name:ANIKWUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-364-4216
Mailing Address - Street 1:5109 MONROE RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7879
Mailing Address - Country:US
Mailing Address - Phone:704-364-4216
Mailing Address - Fax:704-366-6391
Practice Address - Street 1:5109 MONROE RD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7878
Practice Address - Country:US
Practice Address - Phone:704-364-4216
Practice Address - Fax:704-366-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207Q00000X
NC2014-02373208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty