Provider Demographics
NPI:1629079991
Name:WAYNE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:WAYNE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:330-264-9590
Mailing Address - Street 1:203 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4797
Mailing Address - Country:US
Mailing Address - Phone:330-264-9590
Mailing Address - Fax:330-262-2538
Practice Address - Street 1:203 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4797
Practice Address - Country:US
Practice Address - Phone:330-264-9590
Practice Address - Fax:330-262-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0290050251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFV95231OtherMEDICARE ADVANTAGE
OH0515035Medicaid
OH600001994OtherRAILROAD MEDICARE
OH0515035Medicaid
OHFV95231Medicare PIN