Provider Demographics
NPI:1447488374
Name:WJ MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:WJ MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-846-6500
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:405 S. JEFFERSON AVE.
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-0070
Mailing Address - Country:US
Mailing Address - Phone:336-846-6500
Mailing Address - Fax:663-846-7900
Practice Address - Street 1:405 S. JEFFERSON AVE.
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-0070
Practice Address - Country:US
Practice Address - Phone:336-846-6500
Practice Address - Fax:663-846-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35762261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891098UMedicaid
NCC22358Medicare UPIN