Provider Demographics
NPI:1821091059
Name:WAYNESBORO HOSPITAL
Entity Type:Organization
Organization Name:WAYNESBORO HOSPITAL
Other - Org Name:WELLSPAN WAYNESBORO HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-442-3373
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2353
Practice Address - Country:US
Practice Address - Phone:717-765-4000
Practice Address - Fax:717-765-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PA234301282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000111264Medicaid
MD235019OtherOPTIMUM CHOICE
MD792988OtherMAPSI
PA25331OtherSENIOR PARTNERS
PA6491440OtherAETNA
MD809534OtherPRIORITY PARTNERS JOHN HO
WV0171193000Medicaid
TX072768701Medicaid
NY02567664Medicaid
SC10368BMedicaid
PA1007424870006Medicaid
NC3900138Medicaid
VA010040744Medicaid
MT0413202Medicaid
PA1489OtherHIGHMARK BLUE SHIELD
PA1007424870006Medicaid
WV0171193000Medicaid
MD792988OtherMAPSI
MD235019OtherOPTIMUM CHOICE
PA39U138Medicare ID - Type Unspecified