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Organization
WAYNE COUNTY HOSPITAL
Active
Organization
WAYNE COUNTY HOSPITAL
Active
Other names
Prairie Trails Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HENDERSON (CLINIC ADMINISTRATOR)
(641) 872-2260
Entity
Organization
Contact information
Practice address
100 E SOUTH ST, CORYDON, IA 50060-1724
(641) 872-2514
Mailing address
PO BOX 284, CORYDON, IA 50060-0284
(641) 872-2514
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
08461
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70326
BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM
IA
Enumeration date
06/24/2008
Last updated
06/24/2008
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