Provider Demographics
NPI:1912017419
Name:SMETANA, WAYNE ROBERT (C/AAA, MHA)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ROBERT
Last Name:SMETANA
Suffix:
Gender:M
Credentials:C/AAA, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CAISSON HILL ROAD - IRWIN ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:ATTN: MCXX-CLD-QM (CRED) TERRY HILL
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-5037
Mailing Address - Country:US
Mailing Address - Phone:785-239-7155
Mailing Address - Fax:785-239-7364
Practice Address - Street 1:600 CAISSON HILL ROAD - IRWIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:ATTN: MCXX-CLD-QM (CRED) TERRY HILL
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5037
Practice Address - Country:US
Practice Address - Phone:785-239-7155
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist