Provider Demographics
NPI:1578757936
Name:WAVERLY HEALTH CENTER
Entity Type:Organization
Organization Name:WAVERLY HEALTH CENTER
Other - Org Name:NOAH CAMPUS HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRACHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-352-4120
Mailing Address - Street 1:100 WARTBURG BLVD STE 1392
Mailing Address - Street 2:WARTBURG WAVERLY SPORTS AND WELLNESS CENTER
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2215
Mailing Address - Country:US
Mailing Address - Phone:319-352-8436
Mailing Address - Fax:319-352-3992
Practice Address - Street 1:100 WARTBURG BLVD STE 1392
Practice Address - Street 2:WARTBURG WAVERLY SPORTS AND WELLNESS CENTER
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2215
Practice Address - Country:US
Practice Address - Phone:319-352-8436
Practice Address - Fax:319-352-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty