Provider Demographics
NPI:1841239332
Name:WAYNE COUNTY HOSPITAL INC
Entity Type:Organization
Organization Name:WAYNE COUNTY HOSPITAL INC
Other - Org Name:WAYNE COUNTY HOSPITAL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-348-9343
Mailing Address - Street 1:166 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2416
Mailing Address - Country:US
Mailing Address - Phone:606-340-3251
Mailing Address - Fax:606-340-3258
Practice Address - Street 1:166 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2416
Practice Address - Country:US
Practice Address - Phone:606-348-9343
Practice Address - Fax:606-340-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38039207Q00000X
KY02809207Q00000X
261QR1300X
KY3003023363L00000X
KY3002658363LF0000X
KY3005366363LF0000X
KY3006854363LF0000X
KY3008997363LF0000X
KY3009271363LF0000X
KY3010334363LF0000X
KYTP987261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0101046OtherUNITED HEALTHCARE
KY000000057551OtherANTHEM-RURAL HEALTH CLINI
KY000000076139OtherANTHEM BC
KY35000702Medicaid
KY0101046OtherUNITED HEALTHCARE
KY35000702Medicaid