Healthcare Provider Details

I. General information

NPI: 1083775860
Provider Name (Legal Business Name): WAYNE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 4 BOX 4515
PIEDMONT MO
63957-9417
US

IV. Provider business mailing address

RR 4 BOX 4515
PIEDMONT MO
63957-9417
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-4233
  • Fax: 573-223-2136
Mailing address:
  • Phone: 573-223-4233
  • Fax: 573-223-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number263933
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID ANDREW GAYLE
Title or Position: MEMBER
Credential: M.D.
Phone: 573-223-4233