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General NPI Number Information
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NPI Number | 1669670816
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Entity Type | Organization
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Legal Business Name | WAYNESBURG CLINIC, PLLC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 14098 US HIGHWAY 27 S
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City | WAYNESBURG
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State | KY
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Zip | 40489-8253
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Country | US
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Telephone | 606-379-6646
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Fax | 606-379-5707
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Provider Business Mailing Address
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Address Line | PO BOX 435
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City | WAYNESBURG
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State | KY
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Zip | 40489-0435
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Country | US
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Telephone | 606-379-6646
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Fax | 606-379-5707
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHRISTOPHER DUVALL SIMS
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Credential | M.D.
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Telephone | 606-365-1547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 900205
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License Number State | KY
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