Provider Demographics
NPI:1699760926
Name:WAKE INTERNAL MEDICINE CONSULTANTS, INC.
Entity type:Organization
Organization Name:WAKE INTERNAL MEDICINE CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-781-7500
Mailing Address - Street 1:3237 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8036
Mailing Address - Country:US
Mailing Address - Phone:919-781-7500
Mailing Address - Fax:919-881-9586
Practice Address - Street 1:3237 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8036
Practice Address - Country:US
Practice Address - Phone:919-781-7500
Practice Address - Fax:919-881-9586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902915Medicaid
NC0435Medicare ID - Type Unspecified