Provider Demographics
NPI:1184840241
Name:WAYNESBORO FAMILY MEDICAL ASSOCIATES, LLP
Entity type:Organization
Organization Name:WAYNESBORO FAMILY MEDICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-762-9118
Mailing Address - Street 1:1051 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2318
Mailing Address - Country:US
Mailing Address - Phone:717-762-9118
Mailing Address - Fax:717-762-2860
Practice Address - Street 1:1051 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2318
Practice Address - Country:US
Practice Address - Phone:717-762-9118
Practice Address - Fax:717-762-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007427810006Medicaid