Healthcare Provider Details

I. General information

NPI: 1386691913
Provider Name (Legal Business Name): WAYNESVILLE MEDICAL INVESTORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BIRCH LN
WAYNESVILLE MO
65583-2275
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 573-774-6456
  • Fax: 573-774-6778
Mailing address:
  • Phone: 423-473-5751
  • Fax: 423-339-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number29823
License Number StateMO

VIII. Authorized Official

Name: CINDY S CROSS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 423-473-5867