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Wayne County Hospital

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

NPI 1487746764 · NPPES record last updated Dec 30, 2016

Key facts

NPI
1487746764
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
WAYNE COUNTY HOSPITAL
Practice address
101 Main St
Lineville, IA 50147-8517
Phone
(641) 876-2070
Fax
(641) 876-2458
NPI assigned
Sep 28, 2006
Organization subpart
No

Authorized official

Name
Susan Henderson
Title
Clinic Administrator
Phone
(641) 872-5341

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 with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 7

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

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 49

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

View all 49

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0885460Lineville Medical Clinic
101 Main Street, Lineville, IA 50147		Provider-performed microscopyApr 10, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

Rural health clinic certification: CCN 163435

Legal name
WAYNE COUNTY HOSPITAL
Doing business as
LINEVILLE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 15, 1995
Last certification
Aug 19, 2025
Ownership / control type
Non-profit – church related
Organization structure
Government · Non-profit
Enrollment address
101 Main St
Lineville, IA 50147-8517
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
Cfo		 Dec 1, 2014
W-2 Managing Employee Sep 1, 2010
Rhonda Ewing
Individual 		Corporate Director Jan 1, 2015
Darrell Cook
Individual 		Corporate Director Jan 1, 2010
Daren L Relph
Individual 		Corporate Officer
Ceo		 Jun 1, 2010 100%
W-2 Managing Employee Dec 31, 2009
Donna Donald
Individual 		Corporate Director Jan 1, 2008
Wayne County Hospital
Organization · Corydon, IA 		5% Or Greater Direct Ownership Interest Jan 13, 2010
Cynthia Shelley
Individual 		Corporate Director Jan 1, 2021
Dewayne Watters
Individual 		Corporate Director Jun 1, 2021
Jill Tueth
Individual 		Corporate Director 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
Seymour Medical Clinic
Seymour, IA · CCN 168541		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2010
South Central Iowa Medical Clinic
Corydon, IA · CCN 168547		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2011
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
O20100202000547 IA Part a Provider - Rural Health Clinic 4082508734 Practice locations: Lineville, IA

National Provider Directory

Tax ID family
Joel Wells DO (8 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X
Rural Health Clinic/Center 261QR1300X Yes
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X

Addresses

Primary practice location

101 Main St
Lineville, IA 50147-8517

Mailing address

PO Box 283
Corydon, IA 50060-0283

Other names

  • LINEVILLE MEDICAL CLINIC Doing business as

Other providers in Lineville, IA

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

Sources for this page

Verify at the official NPI Registry.