1548255458 NPI number — WAYNE COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1548255458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548255458 NPI number — WAYNE COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE COUNTY HEALTH DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WAYNE COUNTY HOME HEALTH CARE AGENCY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548255458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25570-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-272-6761
Provider Business Mailing Address Fax Number:
304-272-6763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 RAILROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25570-9706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-272-6761
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PLYMALE
Authorized Official First Name:
MELVIN
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
304-272-6761

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0021424001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".