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General NPI Number Information
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NPI Number | 1346000569
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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 | 03/22/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 600 MAPLE AVE STE 4
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City | HONESDALE
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State | PA
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Zip | 18431-1436
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Country | US
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Telephone | 570-253-8177
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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 | 570-253-8226
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TERESA ROSE LACEY
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Credential |
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Telephone | 570-253-8451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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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 | 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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