MEDICARE: WAYT HEALTH CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	18396	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952596769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYT HEALTH CARE, PLLC

Provider Business Mailing Address
First Line	:	1612 WHEELING AVE
Second Line	:
City	:	GLEN DALE
State	:	WV
Zip	:	26038-1734
Country	:	US
Telephone Number	:	304-845-5700
Fax Number	:	304-845-7400

Provider Business Practice Location Address
First Line	:	1612 WHEELING AVE
Second Line	:
City	:	GLEN DALE
State	:	WV
Zip	:	26038-1734
Country	:	US
Telephone Number	:	304-845-5700
Fax Number	:	304-845-7400

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MICHAEL TIMOTHY WAYT
Credential	:	M.D.
Telephone Number	:	304-845-5700

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	12/31/2009

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