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Wayne County Hospital

Organization Active NPI Rural Health Clinic/Center · Corydon, IA

NPI 1104125822 · NPPES record last updated Nov 21, 2017

Key facts

NPI
1104125822
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
WAYNE COUNTY HOSPITAL
Practice address
417 S East St
Suite 100
Corydon, IA 50060-1860
Phone
(641) 872-2063
Fax
(641) 872-2070
NPI assigned
Mar 21, 2011
Organization subpart
No

Authorized official

Name
Daren L Relph
Title
Chief Executive Officer
Phone
(641) 872-2260

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IA

Rural health clinic certification: CCN 168547

Legal name
WAYNE COUNTY HOSPITAL
Doing business as
SOUTH CENTRAL IOWA MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 8, 2012
Last certification
Jun 21, 2018
Ownership / control type
Non-profit – church related
Organization structure
Other · Non-profit
Enrollment address
417 S East St
Ste 100
Corydon, IA 50060-1860
Related CCNs
161358

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Denise a Hook
Individual 		Corporate Officer
Chief Financial Officer		 Aug 27, 2010
Operational/Managerial Control
Cfo		 Jan 1, 2011
Rhonda Ewing
Individual 		Corporate Director Jan 1, 2015
Darrell Cook
Individual 		Corporate Director
Board Member		 Jan 1, 2010
Daren L Relph
Individual 		Corporate Officer
Chief Executive Officer		 Jun 1, 2010 100%
Operational/Managerial Control
Ceo		 Jun 1, 2010 100%
Donna Donald
Individual 		Corporate Director Jan 1, 2008
Wayne County Hospital
Organization · Corydon, IA 		5% Or Greater Direct Ownership Interest Apr 1, 2011 100%
Cynthia Shelley
Individual 		Corporate Director Jan 1, 2021
Dewayne Watters
Individual 		Corporate Director Jun 1, 2021
Jill Tueth
Individual 		Corporate Director
Board Member		 Jan 1, 2010
Bridget Davis
Individual 		Corporate Director Aug 1, 2021

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lineville Medical Clinic
Lineville, IA · CCN 163435		 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 13, 2010
Seymour Medical Clinic
Seymour, IA · CCN 168541		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2010
Humeston Family Medical Clinic
Humeston, IA · CCN 168548		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040212000233 IA Part B Supplier - Clinic/Group Practice 4082508734 Receives reassigned benefits from 59 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Corydon, IA; Humeston, IA; Seymour, ID
O20120328000047 IA Part a Provider - Rural Health Clinic 4082508734 Practice locations: Corydon, IA

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/wayneco-3602361a

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Rural Health Clinic/Center 261QR1300X Yes
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X
Advanced Practice Midwife
Group: 193200000X MULTI-SPECIALTY GROUP		 367A00000X

Addresses

Primary practice location

417 S East St
Suite 100
Corydon, IA 50060-1860

Mailing address

PO Box 305
Corydon, IA 50060-0305
Phone (641) 872-5351

Other names

  • South Central Iowa Medical Clinic Doing business as

Other providers in Corydon, IA

All providers in Corydon, IA · Rural Health Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.