Organization
WAYNE COMMUNITY HEALTH CENTERS INC.
Active
Other names
Southwest/WCHC Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN CHRISTENSEN (CEO)
(435) 425-3744
Entity
Organization
Contact information
Practice address
601 EAST CENTER STREET, PANGUITCH, UT 84759
(435) 826-4374
(435) 826-4354
Mailing address
PO BOX 303, WAYNE COMMUNITY HEALTH CENTERS INC., BICKNELL, UT 84715-0303
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
362182-3501
UT
261QM1300X
Multi-Specialty Clinic/Center
362182-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055193
MEDICARE PART B OSCAR
UT
Enumeration date
05/18/2016
Last updated
11/29/2016
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