NPIMap

Organization Active NPI

Wayne General Hospital

Doing business as Wayne General Eeg

  • Neuromusculoskeletal Medicine & OMM Physician
  • Waynesboro, MS
National Provider Identifier
1720203367
Registry record updated May 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X
License
11-288 Issued in MS
Legal business name
WAYNE GENERAL HOSPITAL
Doing business as
Wayne General Eeg
Practice address
950 Matthew Dr
Waynesboro, MS 39367-2567
Phone
(601) 735-5151
Fax
(601) 735-7168
NPI assigned
Apr 17, 2007
Last updated
May 18, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
WAYNE GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 18, 2015

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

Authorized official

Name
Mrs. Kathy Waddell
Title
Administrator
Phone
(601) 735-5151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 11-288 MS Primary

Addresses

Primary practice location

950 Matthew Dr
Waynesboro, MS 39367-2567

Mailing address

950 Matthew Dr
P O Box 1249
Waynesboro, MS 39367-2567
Phone (601) 735-5151

Other identifiers 1

IdentifierTypeStateIssuer
09013098MedicaidMS

Other names 1

  • WAYNE GENERAL EEG Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623000865 MS Part B Supplier - Clinic/Group Practice 2668457581 Receives reassigned benefits from 51 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waynesboro, MS

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Arthur E Medical Clinic14 organizations share this tax ID, including this one
Part of
Arthur E Medical Clinic

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1720203367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 MATTHEW DR",
            "address_2": "P O BOX 1249",
            "city": "WAYNESBORO",
            "state": "MS",
            "postal_code": "393672567",
            "telephone_number": "601-735-5151",
            "fax_number": "601-735-7168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 MATTHEW DR",
            "city": "WAYNESBORO",
            "state": "MS",
            "postal_code": "393672567",
            "telephone_number": "601-735-5151",
            "fax_number": "601-735-7168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAYNE GENERAL HOSPITAL",
        "enumeration_date": "2007-04-17",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-735-5151",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MS",
            "license": "11-288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013098",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAYNE GENERAL EEG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waynesboro, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; 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.

Verify at the official NPI Registry.