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General NPI Number Information
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NPI Number | 1871739151
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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 | 12/17/2008
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 626 PARK ST
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City | HONESDALE
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State | PA
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Zip | 18431-1446
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Country | US
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Telephone | 570-253-3005
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Fax | 570-253-0181
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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 | 570-253-3005
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Fax | 570-253-0181
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Authorized Official
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Title or Position | EXECUTIVE 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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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 | 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 | PA
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