1619959848 NPI number — WAYNE HEALTH SERVICES, INC.

Table of content: (NPI 1619959848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619959848 NPI number — WAYNE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE HEALTH SERVICES, INC.
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 HEALTH EQUIPMENT AND SERVICES, INC.
Provider Other Organization Name Type Code:
4
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:
1619959848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONESDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18431-1456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-253-6770
Provider Business Mailing Address Fax Number:
570-251-6585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONESDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18431-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-253-6770
Provider Business Practice Location Address Fax Number:
570-251-6585
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LATZKO
Authorized Official First Name:
BARRIE
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
570-253-6770

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1007277580007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1510801 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 806306 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 814226 . This is a "FIRST PRIORITY HEALTH ORT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 88701 . This is a "MED PLUS/THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A937331 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207310 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 497868 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 606096 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30178 . This is a "GEISINGER HEALTH/GOLD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01238013 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1445280 . This is a "BC ACCESS ORTHOTIC/PROTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3Y0296 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1065005 . This is a "W VIRGINIA WORKERS COMP" identifier . This identifiers is of the category "OTHER".




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