Healthcare Provider Details

I. General information

NPI: 1871014092
Provider Name (Legal Business Name): WAYNE COMMUNITY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NORTH CENTER STREET
ESCALANTE UT
84776-0276
US

IV. Provider business mailing address

PO BOX 303
BICKNELL UT
84715-0303
US

V. Phone/Fax

Practice location:
  • Phone: 435-826-4333
  • Fax: 435-826-4336
Mailing address:
  • Phone: 435-425-3744
  • Fax: 435-425-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateUT

VIII. Authorized Official

Name: MR. EVAN CHRISTENSEN
Title or Position: CEO
Credential:
Phone: 435-425-1102