1184621161 NPI number — WAYNE HOSPITAL COMPANY

Table of content: (NPI 1184621161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184621161 NPI number — WAYNE HOSPITAL COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE HOSPITAL COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WAYNE HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184621161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 SWEITZER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45331-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-548-1141
Provider Business Mailing Address Fax Number:
937-547-5784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 SWEITZER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45331-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-548-1141
Provider Business Practice Location Address Fax Number:
937-547-5784
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GILLESPIE
Authorized Official First Name:
NICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
937-569-6758

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NR1301X , with the licence number: 1159 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0023881 . This is a "TRICARE OUTPATIENT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 31365 . This is a "BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 100275920A . This is a "INDIANA MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 36U044 . This is a "MEDICARE SWING BED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0012795 . This is a "TRICARE INPATIENT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5020011 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0000003011 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9250484 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107250300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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