Healthcare Provider Details

I. General information

NPI: 1568886000
Provider Name (Legal Business Name): WAYNE COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 E MOQUI LN
ESCALANTE UT
84726-0276
US

IV. Provider business mailing address

PO BOX 303
BICKNELL UT
84715-0303
US

V. Phone/Fax

Practice location:
  • Phone: 435-826-4374
  • Fax:
Mailing address:
  • Phone: 435-425-3744
  • Fax: 435-425-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: EVAN CHRISTENSEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 435-425-3744