NPIMap

Organization Active NPI

Wayne Memorial Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Honesdale, PA
National Provider Identifier
1407091077
Registry record updated Jul 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Practice address
601 Park St
Honesdale, PA 18431-1445
Phone
(570) 251-6676
Fax
(570) 251-6668
NPI assigned
Dec 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Frederick Jackson
Title
Executive Director
Phone
(570) 253-8450

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

601 Park St
Honesdale, PA 18431-1445

Mailing address

29 Woodlands Dr
Waymart, PA 18472-9366
Phone (570) 251-6676

Other names 1

  • WAYMART FAMILY HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100315000770 PA Part A Provider - Federally Qualified Health Center (FQHC) 3072598937 Practice locations: Waymart, PA

Federally qualified health center certification: CCN 391007

Legal name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 18, 2010
Last certification
Mar 18, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 25, 1981 in PA
Enrollment address
29 Woodlands Dr
Waymart, PA 18472-9366

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Hamlin Family Health Center27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carrie Demers Individual Corporate Director Jul 1, 2016
John Brennan Individual Corporate Director Sep 1, 2024
Pamela Sader Treanor Individual Corporate Director Sep 1, 2024
Michelle Louise Wonders Individual Corporate DirectorVice Chairman May 1, 2018
Steven Guccini Individual Corporate DirectorTreasurer Jan 1, 2020
Gregory Capitolo Individual Corporate DirectorChairman Feb 1, 2019
Cinda Tietjen Individual Corporate DirectorSecretary Dec 1, 2023
Robert Fortuner Individual W-2 Managing Employee Feb 1, 2015
Timothy Knapp Individual Corporate Director Jan 1, 2024
Charles Curtin Individual Corporate Director Sep 1, 2024
Judit Vegh Individual Corporate Director Jan 1, 2024
Teresa Lacey Individual Corporate Officer Feb 1, 2023
W-2 Managing Employee Feb 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 47

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278892800000",
    "number": "1407091077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 WOODLANDS DR",
            "city": "WAYMART",
            "state": "PA",
            "postal_code": "184729366",
            "telephone_number": "570-251-6676",
            "fax_number": "570-251-6668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311445",
            "telephone_number": "570-251-6676",
            "fax_number": "570-251-6668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEMORIAL COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2010-07-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "570-253-8450",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAYMART FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Honesdale, PA

Sources for this page

Verify at the official NPI Registry.