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General NPI Number Information
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NPI Number | 1225304603
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Entity Type | Organization
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Legal Business Name | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 100 DUNDAFF ST
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City | FOREST CITY
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State | PA
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Zip | 18421-1317
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Country | US
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Telephone | 570-785-3194
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Fax |
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Provider Business Mailing Address
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Address Line | 601 PARK ST
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City | HONESDALE
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State | PA
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Zip | 18431-1445
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Country | US
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Telephone | 570-251-6641
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Fax | 570-253-8228
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Authorized Official
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Title or Position | EXCECUTIVE DIRECTOR
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Name | FREDERICK JACKSON
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Credential |
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Telephone | 570-253-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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