Healthcare Provider Details

I. General information

NPI: 1659979193
Provider Name (Legal Business Name): WAYNE COMMUNITY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 02/22/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E MAIN ST # 3
SALINA UT
84654-1335
US

IV. Provider business mailing address

PO BOX 303
BICKNELL UT
84715-0303
US

V. Phone/Fax

Practice location:
  • Phone: 435-529-2215
  • Fax:
Mailing address:
  • Phone: 435-425-3744
  • Fax: 435-425-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty 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: RAMONA LARSEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 435-425-1143