Provider Demographics
NPI:1922168608
Name:WAYNE HEALTH CARE
Entity Type:Organization
Organization Name:WAYNE HEALTH CARE
Other - Org Name:NEWARK-WAYNE COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1223
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-0111
Mailing Address - Country:US
Mailing Address - Phone:315-332-2204
Mailing Address - Fax:315-332-2428
Practice Address - Street 1:1200 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1057
Practice Address - Country:US
Practice Address - Phone:315-332-2204
Practice Address - Fax:315-332-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0126733336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3356866OtherNCPDP
NY00355702Medicaid
NY335403Medicare Oscar/Certification
NY330030Medicare Oscar/Certification