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Organization Active NPI

Wayne County Hospital

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Corydon, IA
National Provider Identifier
1669566824
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
930027H Issued in IA
Legal business name
WAYNE COUNTY HOSPITAL
Practice address
417 S East St
Corydon, IA 50060-1860
Phone
(641) 872-2260
Fax
(641) 872-3116
NPI assigned
Oct 3, 2006
Last updated
Jan 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

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

Authorized official

Name
Susan Henderson
Title
Admin Special Projects
Phone
(641) 872-5341

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 930027H IA 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 names 1

  • DIALYSIS Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111201000778 IA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4082508734 Practice locations: Corydon, IA

Other NPIs with the same Medicare PAC ID 7

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Wayne County Hospital ESRDCCN 162324
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Jun 1, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
5

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Corydon Medica Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Lineville Medical ClinicLineville, IA, CCN 163435 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 13, 2010
Seymour Medical ClinicSeymour, IA, CCN 168541 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2010
South Central Iowa Medical ClinicCorydon, IA, CCN 168547 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2011
Humeston Family Medical ClinicHumeston, IA, CCN 168548 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2011

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1669566824",
    "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",
            "fax_number": "641-872-3116"
        },
        {
            "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",
            "fax_number": "641-872-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ADMIN SPECIAL PROJECTS",
        "authorized_official_telephone_number": "641-872-5341"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "IA",
            "license": "930027H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIALYSIS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Corydon, IA

Sources for this page

Verify at the official NPI Registry.