1194860502 NPI number — TALLAHATCHIE GENERAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194860502 NPI number — TALLAHATCHIE GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLAHATCHIE GENERAL 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:
Provider Other Organization Name Type Code:
6
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:
1194860502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38921-0240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-647-5535
Provider Business Mailing Address Fax Number:
662-647-8432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 DR. T T LEWIS CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38921-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-647-5535
Provider Business Practice Location Address Fax Number:
662-647-8432
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CROCKER
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
DOVER
Authorized Official Title or Position:
HIM DIRECTOR
Authorized Official Telephone Number:
662-625-7176

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09014008 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "BLUE CROSS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "STATE OF MS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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