Healthcare Provider Details

I. General information

NPI: 1487746764
Provider Name (Legal Business Name): WAYNE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST
LINEVILLE IA
50147-8517
US

IV. Provider business mailing address

PO BOX 283
CORYDON IA
50060-0283
US

V. Phone/Fax

Practice location:
  • Phone: 641-876-2070
  • Fax: 641-876-2458
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery 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: SUSAN HENDERSON
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 641-872-5341