Healthcare Provider Details

I. General information

NPI: 1093863342
Provider Name (Legal Business Name): WAYNE COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SOUTH HWY 95
HANKSVILLE UT
84734
US

IV. Provider business mailing address

PO BOX 303
BICKNELL UT
84715-0303
US

V. Phone/Fax

Practice location:
  • Phone: 435-425-3744
  • Fax: 435-425-3785
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 TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DARCI ELMER
Title or Position: BILLING MANAGER
Credential:
Phone: 435-425-1104