Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
Honesdale Pediatric Center
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
1837 FAIR AVE, HONESDALE, PA 18431-2121
(570) 253-5838
(570) 253-6678
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 253-8226
(570) 253-8228
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/09/2019
Last updated
08/28/2020
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