1225023500 NPI number — WAYNE FAMILY HEALTH CARE, P.C.

Table of content: MARJORIE TAYLOR ATR, LCAT, LPC (NPI 1245558584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225023500 NPI number — WAYNE FAMILY HEALTH CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE FAMILY HEALTH CARE, P.C.
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:
Provider Other Organization Name Type Code:
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:
1225023500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 REID PARKWAY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-966-5217
Provider Business Mailing Address Fax Number:
765-966-5277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 REID PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-966-5217
Provider Business Practice Location Address Fax Number:
765-966-5277
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
765-966-5217

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200112000A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2049929 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DEC36280 . This is a "CSHCS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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