Provider Demographics
NPI:1225023500
Name:WAYNE FAMILY HEALTH CARE, P.C.
Entity Type:Organization
Organization Name:WAYNE FAMILY HEALTH CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-966-5217
Mailing Address - Street 1:1050 REID PARKWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374
Mailing Address - Country:US
Mailing Address - Phone:765-966-5217
Mailing Address - Fax:765-966-5277
Practice Address - Street 1:1050 REID PARKWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374
Practice Address - Country:US
Practice Address - Phone:765-966-5217
Practice Address - Fax:765-966-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200112000AMedicaid
OH2049929Medicaid
INDEC36280OtherCSHCS
OH2049929Medicaid