1740380914 NPI number — YALOBUSHA GENERAL HOSPITAL

Table of content: (NPI 1740380914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740380914 NPI number — YALOBUSHA GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YALOBUSHA 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:
YALOBUSHA GENERAL HOSPITAL PROF FEE
Provider Other Organization Name Type Code:
3
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:
1740380914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATER VALLEY
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38965-3468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-473-1403
Provider Business Mailing Address Fax Number:
662-473-4922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATER VALLEY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38965-3468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-473-1403
Provider Business Practice Location Address Fax Number:
662-473-4922
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VARNER
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
662-473-1411

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  11-223 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000020175 . This is a "BCBS HOSPITAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: DF8375 . This is a "RR MEDICARE PROFESSIONAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: DZ0522 . This is a "RR MEDICARE PROFESSIONAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 654763 . This is a "PROFESSIONAL FEES" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: CG7236 . This is a "RR MEDICARE PROFESSIONAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: DZ0522 . This is a "RR MEDICARE PROFESSIONAL FEES" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 000019175 . This is a "BCBS PROFESSIONAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00553961 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 654763 . This is a "MEDICARE PROFESSIONAL FEES" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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