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Organization

WAYNE COMMUNITY HEALTH CENTERS INC

Active
Parent organization
WAYNE COMMUNITY HEALTH CENTERS INC.
Other names
Kazan Ivan W Memorial Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
WAYNE COMMUNITY HEALTH CENTERS INC.
Authorized official
EVAN CHRISTENSEN (EXECUTIVE DIRECTOR)
(435) 425-3744
Entity
Organization

Contact information

Practice address
570 E MOQUI LN, ESCALANTE, UT 84726-0276
(435) 826-4374
Mailing address
PO BOX 303, BICKNELL, UT 84715-0303
(435) 425-3744
(435) 425-3785

Taxonomy

Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
261QM1300X
Multi-Specialty Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000055193
MEDICARE PART B -
UT
Enumeration date
02/04/2014
Last updated
04/21/2021
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