NPIMap

Organization Active NPI

Wayne Community Health Centers Inc.

Doing business as Southwest/WCHC Mental Health

  • Federally Qualified Health Center (FQHC)
  • Panguitch, UT
National Provider Identifier
1891142071
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
362182-3501 Issued in UT
Legal business name
WAYNE COMMUNITY HEALTH CENTERS INC.
Doing business as
Southwest/WCHC Mental Health
Practice address
601 East Center Street
Panguitch, UT 84759
Phone
(435) 826-4374
Fax
(435) 826-4354
NPI assigned
May 18, 2016
Last updated
Nov 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Authorized official

Name
Evan Christensen
Title
Ceo
Phone
(435) 425-3744

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 362182-3501 UT Primary
Multi-Specialty Clinic/Center 261QM1300X 362182-3501 UT
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

601 East Center Street
Panguitch, UT 84759

Mailing address

PO Box 303
Wayne Community Health Centers Inc.
Bicknell, UT 84715-0303

Other identifiers 1

IdentifierTypeStateIssuer
000055193OtherUTMEDICARE PART B OSCAR

Other names 1

  • Southwest/WCHC Mental Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000649 UT Part B Supplier - Clinic/Group Practice 1254242233 Receives reassigned benefits from 27 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bicknell, UT; Escalante, UT; Hanksville, UT; Salina, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891142071. Details of each certification follow.

  • CCN 461855 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 461855

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SOUTHWEST W C H C MENTAL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 16, 2016
Last certification
Aug 16, 2016
Ownership / control type
For profit – corporation
Facility address
601 East Center Street
Panguitch, UT 84759

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1891142071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 303",
            "address_2": "WAYNE COMMUNITY HEALTH CENTERS INC.",
            "city": "BICKNELL",
            "state": "UT",
            "postal_code": "847150303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 EAST CENTER STREET",
            "city": "PANGUITCH",
            "state": "UT",
            "postal_code": "84759",
            "telephone_number": "435-826-4374",
            "fax_number": "435-826-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE COMMUNITY HEALTH CENTERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "435-425-3744"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "UT",
            "license": "362182-3501",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "UT",
            "license": "362182-3501",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B OSCAR",
            "identifier": "000055193",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest/WCHC Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Panguitch, UT

Sources for this page

Verify at the official NPI Registry.