Provider Demographics
NPI:1659979193
Name:WAYNE COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:WAYNE COMMUNITY HEALTH CENTERS, INC
Other - Org Name:SALINA FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-425-1143
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:UT
Mailing Address - Zip Code:84715-0303
Mailing Address - Country:US
Mailing Address - Phone:435-425-3744
Mailing Address - Fax:435-425-3744
Practice Address - Street 1:131 E MAIN ST # 3
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-1335
Practice Address - Country:US
Practice Address - Phone:435-529-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty