Healthcare Provider Details

I. General information

NPI: 1740406776
Provider Name (Legal Business Name): WAYNE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/08/2011
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 TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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