1164544375 NPI number — COVINGTON COUNTY HOSPITAL

Table of content: (NPI 1164544375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164544375 NPI number — COVINGTON COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVINGTON COUNTY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMBULANCE SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164544375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLINS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39428-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-765-6711
Provider Business Mailing Address Fax Number:
601-698-0180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S HOLLY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLINS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39428-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-765-6711
Provider Business Practice Location Address Fax Number:
601-698-0180
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GIBBES
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-698-0101

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00050255 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com