Provider Demographics
NPI:1598787160
Name:WAYNE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WAYNE GENERAL HOSPITAL
Other - Org Name:WAYNE GENERAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-735-7100
Mailing Address - Street 1:951 MATTHEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2566
Mailing Address - Country:US
Mailing Address - Phone:601-735-5500
Mailing Address - Fax:601-735-5533
Practice Address - Street 1:951 MATTHEW DR STE C
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2566
Practice Address - Country:US
Practice Address - Phone:601-735-5500
Practice Address - Fax:601-735-5533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11288251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS257088Medicare ID - Type UnspecifiedMEDICARE HOMEHEALTH