NPIMap

Organization Active NPI

Hospital Authority of Wayne County, Georgia

  • Medicare Defined Swing Bed Hospital Unit
  • Jesup, GA
National Provider Identifier
1205035771
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
HOSPITAL AUTHORITY OF WAYNE COUNTY, GEORGIA
Practice address
865 S 1St St
Jesup, GA 31545-0210
Phone
(912) 427-6811
Fax
(912) 530-3140
NPI assigned
Jul 16, 2007
Organization subpart
Yes
Parent organization
HOSPITAL AUTHORITY OF WAYNE COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Joseph P Ierardi
Title
Administrator
Phone
(912) 530-3302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

865 S 1St St
Jesup, GA 31545-0210

Mailing address

865 S 1St St
Jesup, GA 31545-0210
Phone (912) 427-6811

Other identifiers 1

IdentifierTypeStateIssuer
00002054AMedicaidGA

Other names 1

  • Wayne Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071015000241 GA Part A Provider - Hospital 5698663854 Practice locations: Jesup, GA

Hospital certification: CCN 11U124

Legal name
HOSPITAL AUTHORITY OF WAYNE COUNTY GEORGIA
Doing business as
WAYNE MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Mar 27, 1941 in GA
Enrollment address
865 South First St
Jesup, GA 31545-0210
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Wayne Co Ambulance Co7 organizations share this tax ID, including this one
Part of
Wayne Co Ambulance Co

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Sydney Hendrix Individual Corporate OfficerSecretary-Treasurer Jul 1, 2008
David Keith Individual Corporate Director Jun 13, 2007
Herman Lewis Individual Corporate OfficerVice-Chairman Jul 1, 2018
Joseph Ierardi Individual Corporate Director Apr 30, 2007
W-2 Managing Employee Apr 30, 2007
Brenda Purvis Individual Corporate OfficerChairperson Jul 1, 2018
Gregory Jones Individual Corporate Director Jun 24, 2007
W-2 Managing Employee Jun 24, 2007
John Perry Individual Corporate Director Jun 13, 2007
Douglas Ellis Individual Corporate Director Jun 13, 2007

Owners & managing parties with NPI records 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1205035771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 S 1ST ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315450210",
            "telephone_number": "912-427-6811",
            "fax_number": "912-530-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 S 1ST ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315450210",
            "telephone_number": "912-427-6811",
            "fax_number": "912-530-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF WAYNE COUNTY, GEORGIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL AUTHORITY OF WAYNE COUNTY",
        "enumeration_date": "2007-07-16",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "IERARDI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "912-530-3302",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00002054A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jesup, GA

Sources for this page

Verify at the official NPI Registry.