Provider Demographics
NPI:1871548016
Name:WAYNE COUNTY HOSPITAL, INC
Entity type:Organization
Organization Name:WAYNE COUNTY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
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:42633-2430
Mailing Address - Country:US
Mailing Address - Phone:606-348-9343
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:2006-05-24
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38039207Q00000X, 208M00000X, 207Q00000X
KY02809207Q00000X, 208M00000X
207P00000X, 208600000X
KY35830207R00000X, 208M00000X
KY3003023363L00000X
KY3006854363LF0000X
KY3002658363LF0000X
KY3010334363LF0000X
KY2657A367500000X
KY600074282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054708OtherANTHEM BC
KY74900994Medicaid
KY000000076139OtherANTHEM BC
KY01021781Medicaid
KY000000054709OtherANTHEM- SKILLED NURSING
KY000000057551OtherANTHEM-RURAL HEALTH CLINI
KY000000108553OtherANTHEM BC
KY3500047OtherUNITED HEALTHCARE
KY65923542Medicaid
KY000000382062OtherANTHEM-EMERGENCY MEDICIN
KY000000061965OtherANTHEM BC
KY5000047OtherUNITED HEALTH CARE
KY000000057551OtherANTHEM-RURAL HEALTH CLINI
KY000000108553OtherANTHEM BC
KY=========001OtherTRICARE
KY000000061965OtherANTHEM BC
KY000000108553OtherANTHEM BC