Provider Demographics
NPI:1003204256
Name:WAYNE CO HEALTH DEPT (RFTS)
Entity Type:Organization
Organization Name:WAYNE CO HEALTH DEPT (RFTS)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-272-6761
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-0368
Mailing Address - Country:US
Mailing Address - Phone:304-272-6761
Mailing Address - Fax:304-272-6763
Practice Address - Street 1:217 KENOVA AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-9795
Practice Address - Country:US
Practice Address - Phone:304-272-6761
Practice Address - Fax:304-272-6763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIGHT FROM THE START
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021424003Medicaid