Provider Demographics
NPI:1184621161
Name:WAYNE HOSPITAL COMPANY
Entity type:Organization
Organization Name:WAYNE HOSPITAL COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-569-6758
Mailing Address - Street 1:835 SWEITZER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1007
Mailing Address - Country:US
Mailing Address - Phone:937-548-1141
Mailing Address - Fax:937-547-5784
Practice Address - Street 1:835 SWEITZER ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1007
Practice Address - Country:US
Practice Address - Phone:937-548-1141
Practice Address - Fax:937-547-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
OH1159282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100275920AOtherINDIANA MEDICAID
OH0000003011OtherANTHEM
OH31365OtherBLACK LUNG
OH0012795OtherTRICARE INPATIENT
OH0023881OtherTRICARE OUTPATIENT
OH5020011OtherUNITED HEALTHCARE
OH9250484Medicaid
OH36U044OtherMEDICARE SWING BED
OH5020011OtherUNITED HEALTHCARE
OH=========00OtherBWC
OH100275920AOtherINDIANA MEDICAID
OHWA3600441Medicare ID - Type UnspecifiedMEDICARE PART B
OHLE7355301Medicare PIN
OH3600441Medicare Oscar/Certification
OH360044Medicare Oscar/Certification
OHID366931Medicare PIN
OH0000003011OtherANTHEM