Healthcare Provider Details

I. General information

NPI: 1457421554
Provider Name (Legal Business Name): WAYNE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/09/2011
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: 641-872-2260
  • Fax: 641-872-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HENDERSON
Title or Position: ADMIN SPECIAL PROJECTS
Credential:
Phone: 641-872-5341