Provider Demographics
NPI:1902114655
Name:C. BRYAN WAIT, M.D., INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:C. BRYAN WAIT, M.D., INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVERT
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WAIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-244-0238
Mailing Address - Street 1:360 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1608
Mailing Address - Country:US
Mailing Address - Phone:260-244-0238
Mailing Address - Fax:260-244-1976
Practice Address - Street 1:2003 STULTS RD
Practice Address - Street 2:JOHN B. KAY MOB, SUITE 110
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-244-0238
Practice Address - Fax:260-244-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200963590BMedicaid
IN263500Medicare PIN