Healthcare Provider Details

I. General information

NPI: 1457902314
Provider Name (Legal Business Name): WAYNE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E JEFFERSON ST STE A
CORYDON IA
50060-1812
US

IV. Provider business mailing address

PO BOX 305
CORYDON IA
50060-0305
US

V. Phone/Fax

Practice location:
  • Phone: 641-872-2030
  • Fax: 641-872-2031
Mailing address:
  • Phone: 641-872-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DENISE ANNE HOOK
Title or Position: CFO
Credential:
Phone: 641-872-2260