Healthcare Provider Details

I. General information

NPI: 1174599468
Provider Name (Legal Business Name): WAYNE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S EAST ST
CORYDON IA
50060-1860
US

IV. Provider business mailing address

PO BOX 305
CORYDON IA
50060-0305
US

V. Phone/Fax

Practice location:
  • Phone: 641-872-2260
  • Fax: 641-872-3116
Mailing address:
  • Phone: 641-872-5341
  • Fax: 641-872-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HENDERSON
Title or Position: DIRECTOR, ADMINISTRATIVE SERVICES
Credential:
Phone: 641-872-5341