Provider Demographics
NPI:1720046980
Name:WESTERN WAYNE MEDICAL CENTER
Entity Type:Organization
Organization Name:WESTERN WAYNE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-735-1400
Mailing Address - Street 1:2280 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9546
Mailing Address - Country:US
Mailing Address - Phone:919-735-1400
Mailing Address - Fax:919-581-0353
Practice Address - Street 1:2280 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9546
Practice Address - Country:US
Practice Address - Phone:919-735-1400
Practice Address - Fax:919-581-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32555261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical