Basic Information
Provider Information
NPI: 1124043153
EntityType: 2
ReplacementNPI:  
OrganizationName: WAVERLY HEALTH CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: WAVERLY MUNICIPAL HOSPITAL
OtherOrganizationType: 4
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 312 9TH ST SW
Address2:  
City: WAVERLY
State: IA
PostalCode: 506772929
CountryCode: US
TelephoneNumber: 3193524120
FaxNumber: 3193523992
Practice Location
Address1: 312 9TH ST SW
Address2:  
City: WAVERLY
State: IA
PostalCode: 506772929
CountryCode: US
TelephoneNumber: 3193524120
FaxNumber: 3193523992
Other Information
ProviderEnumerationDate: 07/12/2006
LastUpdateDate: 03/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BENNETT
AuthorizedOfficialFirstName: LISA
AuthorizedOfficialMiddleName: A.
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 3193524120
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: WAVERLY HEALTH CENTER
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC0060X090098HIAN HospitalsGeneral Acute Care HospitalCritical Access
275N00000X090098HIAY Hospital UnitsMedicare Defined Swing Bed Unit 

ID Information
IDTypeStateIssuerDescription
6609401IABCBS SWINGOTHER


Home