Provider Demographics
NPI:1063878676
Name:WAYNE GENERAL HOSPITAL
Entity type:Organization
Organization Name:WAYNE GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-735-7100
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:940 MATTHEW DRIVE, SUITE 8
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-1249
Mailing Address - Country:US
Mailing Address - Phone:601-735-7101
Mailing Address - Fax:601-735-7181
Practice Address - Street 1:940 MATTHEW DR STE 8
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2534
Practice Address - Country:US
Practice Address - Phone:601-735-7101
Practice Address - Fax:601-735-7181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-12
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty