Healthcare Provider Details

I. General information

NPI: 1275825838
Provider Name (Legal Business Name): WAYNE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BROAD ST
HUMESTON IA
50123-7736
US

IV. Provider business mailing address

PO BOX 305
CORYDON IA
50060-0305
US

V. Phone/Fax

Practice location:
  • Phone: 641-877-6108
  • Fax: 641-877-6123
Mailing address:
  • Phone: 641-872-5341
  • Fax: 641-872-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAREN L RELPH
Title or Position: CEO
Credential:
Phone: 641-872-2260