Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
HONESDALE FAMILY HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
600 MAPLE AVE, HONESDALE, PA 18431-1459
(570) 251-6672
(570) 253-8992
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 253-8226
(570) 253-8228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007765560005
—
PA
Enumeration date
01/11/2008
Last updated
04/07/2015
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