Basic Information
| Provider Information | |||||||||
| NPI: | 1821091059 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WAYNESBORO HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WELLSPAN WAYNESBORO HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172682353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177654000 | ||||||||
| FaxNumber: | 7177653498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUCZKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 4104423373 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 282N00000X | 234301 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000000111264 | 05 | PA | MEDICAID | 235019 | 01 | MD | OPTIMUM CHOICE | OTHER | 792988 | 01 | MD | MAPSI | OTHER | 25331 | 01 | PA | SENIOR PARTNERS | OTHER | 6491440 | 01 | PA | AETNA | OTHER | 809534 | 01 | MD | PRIORITY PARTNERS JOHN HO | OTHER | 0171193000 | 05 | WV | MEDICAID | 072768701 | 05 | TX | MEDICAID | 02567664 | 05 | NY | MEDICAID | 10368B | 05 | SC | MEDICAID | 1007424870006 | 05 | PA | MEDICAID | 3900138 | 05 | NC | MEDICAID | 010040744 | 05 | VA | MEDICAID | 0413202 | 05 | MT | MEDICAID | 1489 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |