NPIMap

Organization Active NPI

Wayne General Hospsital

Doing business as Wayne General Ekg

  • Interventional Cardiology Physician
  • Waynesboro, MS
National Provider Identifier
1902021546
Registry record updated May 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
11-288 Issued in MS
Legal business name
WAYNE GENERAL HOSPSITAL
Doing business as
Wayne General Ekg
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 HOSPTIALAs 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
Interventional Cardiology Physician 207RI0011X 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
09013806MedicaidMS

Other names 1

  • WAYNE GENERAL EKG 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
Part of
Arthur E Medical Clinic

Locations

951 Matthew Dr
Ste A
Waynesboro, MS 39367
Phone (601) 735-2401

951 Matthew Dr
Ste E
Waynesboro, MS 39367

Practitioners & affiliated clinicians

Practitioners 63

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.

View all 63

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": "1902021546",
    "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 HOSPSITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAYNE GENERAL HOSPTIAL",
        "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": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MS",
            "license": "11-288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013806",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAYNE GENERAL EKG",
            "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.