Provider Demographics
NPI:1750436002
Name:VILLAGE OF WAYNE CITY
Entity type:Organization
Organization Name:VILLAGE OF WAYNE CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VILLAGE OF WAYNE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-895-2241
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:WAYNE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62895-0176
Mailing Address - Country:US
Mailing Address - Phone:618-895-2241
Mailing Address - Fax:618-895-2577
Practice Address - Street 1:103 MILL STREET
Practice Address - Street 2:
Practice Address - City:WAYNE CITY
Practice Address - State:IL
Practice Address - Zip Code:62895-0176
Practice Address - Country:US
Practice Address - Phone:618-895-2241
Practice Address - Fax:618-895-2241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF WAYNE CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL551603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
4351483OtherCIGNA
096320212OtherBLUECROSS BLUESHIELD
115266OtherHEALTHLINK
IL=========01Medicaid
IL=========01Medicaid