Provider Demographics
NPI:1164472866
Name:WAVERLEY HEALTH CARE CONSULTANTS, INC.
Entity Type:Organization
Organization Name:WAVERLEY HEALTH CARE CONSULTANTS, INC.
Other - Org Name:HEALTH CARE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:601-956-1576
Mailing Address - Street 1:PO BOX 12000
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-2000
Mailing Address - Country:US
Mailing Address - Phone:601-956-1576
Mailing Address - Fax:
Practice Address - Street 1:460 BRIARWOOD DR
Practice Address - Street 2:SUITE 410
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3051
Practice Address - Country:US
Practice Address - Phone:601-956-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0618408332B00000X, 332BP3500X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0820120001Medicare NSC