Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
McAndrew Family Health Center, Forest City Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXCECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
100 DUNDAFF ST, FOREST CITY, PA 18421-1317
(570) 785-3194
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 251-6641
(570) 253-8228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007765560020
—
PA
Enumeration date
03/29/2012
Last updated
08/28/2020
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