Provider Demographics
NPI:1396978169
Name:WAYNE HEALTH PHYSICIANS
Entity type:Organization
Organization Name:WAYNE HEALTH PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-587-4081
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-0250
Mailing Address - Country:US
Mailing Address - Phone:800-634-0201
Mailing Address - Fax:866-727-0896
Practice Address - Street 1:2400 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE J
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1789
Practice Address - Country:US
Practice Address - Phone:919-587-4081
Practice Address - Fax:919-587-0775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-27
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913954Medicaid
NC5913954Medicaid