Provider Demographics
NPI:1275825838
Name:WAYNE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:WAYNE COUNTY HOSPITAL
Other - Org Name:HUMESTON FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RELPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-872-2260
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-0305
Mailing Address - Country:US
Mailing Address - Phone:641-872-5341
Mailing Address - Fax:641-872-3116
Practice Address - Street 1:109 BROAD ST
Practice Address - Street 2:
Practice Address - City:HUMESTON
Practice Address - State:IA
Practice Address - Zip Code:50123-7736
Practice Address - Country:US
Practice Address - Phone:641-877-6108
Practice Address - Fax:641-877-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty