Organization Name: | WAYNE MEDICAL CENTER LLC |
NPI Number: | 1083775860 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID ANDREW GAYLE (MEMBER) |
Mailing Address: | Rr 4 Box 4515 Piedmont |
State: | MO US |
Postal Code: | 639579417 |
Phone Number: | 5732234233 |
Fax Number: | 5732232136 |
NPI Enumeration Date: | 12/13/2006 |
NPI Last Update Date: | 01/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 263933 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |