Healthcare Provider Details

I. General information

NPI: 1629079991
Provider Name (Legal Business Name): WAYNE COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WALNUT ST
WOOSTER OH
44691-4797
US

IV. Provider business mailing address

203 S WALNUT ST
WOOSTER OH
44691-4797
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-9590
  • Fax: 330-262-2538
Mailing address:
  • Phone: 330-264-9590
  • Fax: 330-262-2538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number02-0290050
License Number StateOH

VIII. Authorized Official

Name: MR. GREGORY L. HALLEY
Title or Position: HEALTH COMMISSIONER
Credential: M.D., M.B.A.
Phone: 330-264-9590