1861586810 NPI number — WAYNE FAMILY MEDICAL CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861586810 NPI number — WAYNE FAMILY MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE FAMILY MEDICAL CENTER, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1861586810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORYDON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50060-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-872-2063
Provider Business Mailing Address Fax Number:
641-872-2070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 S EAST ST
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
CORYDON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50060-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-872-2063
Provider Business Practice Location Address Fax Number:
641-872-2070
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUPE
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
641-872-2063

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CI4009 . This is a "R.R. MCARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 03040 . This is a "BC/BS GROUP NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0070342 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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