Provider Demographics
NPI:1952596769
Name:WAYT HEALTH CARE, PLLC
Entity type:Organization
Organization Name:WAYT HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:WAYT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-845-5700
Mailing Address - Street 1:1612 WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1734
Mailing Address - Country:US
Mailing Address - Phone:304-845-5700
Mailing Address - Fax:304-845-7400
Practice Address - Street 1:1612 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1734
Practice Address - Country:US
Practice Address - Phone:304-845-5700
Practice Address - Fax:304-845-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0047663000Medicaid
WV0047663000Medicaid