1023326485 NPI number — WALTHALL GENERAL HOSPITAL

Table of content: (NPI 1023326485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023326485 NPI number — WALTHALL GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALTHALL 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:
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:
1023326485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-288-1889
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLERTOWN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39667-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-876-2122
Provider Business Practice Location Address Fax Number:
601-222-0432
Provider Enumeration Date:
09/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HESTER
Authorized Official First Name:
BEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
601-288-4225

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  11-257 , 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: 251324 . This is a "MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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