Active NPI
Wayne County Hospital
- Surgery Physician
- Corydon, IA
National Provider Identifier
1235308958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- WAYNE COUNTY HOSPITAL
- Practice address
- 417 S East St
Corydon, IA 50060-1860 - Phone
- (641) 872-2260
- NPI assigned
- Feb 27, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daren Relph
- Title
- Ceo
- Phone
- (641) 872-5258
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
417 S East St
Corydon, IA 50060-1860
Mailing address
PO Box 305
Corydon, IA 50060-0305
Phone (641) 872-2260
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40836 | Other | BLUE CROSS BLUE SHIELD | |
| 1160853 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Certified Registered Nurse Anesthetist
- Corydon, IA
- NPI 1932325966
O20040212000233
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204070400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1511308800000",
"number": "1235308958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 305",
"city": "CORYDON",
"state": "IA",
"postal_code": "500600305",
"telephone_number": "641-872-2260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 S EAST ST",
"city": "CORYDON",
"state": "IA",
"postal_code": "500601860",
"telephone_number": "641-872-2260"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAYNE COUNTY HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2008-02-27",
"last_updated": "2017-11-22",
"status": "A",
"authorized_official_last_name": "RELPH",
"authorized_official_first_name": "DAREN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "641-872-5258"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "40836",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1160853",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corydon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.