1215013065 NPI number — JASPER 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 1215013065 NPI number — JASPER GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASPER 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:
1215013065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 527
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39422-0527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-764-2101
Provider Business Mailing Address Fax Number:
601-764-2930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15A SOUTH 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39422-0527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-764-2101
Provider Business Practice Location Address Fax Number:
601-764-2930
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POSEY
Authorized Official First Name:
MARSHALL
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
601-764-2101

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  11226 , 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: 5000396 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 000080009 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00029160 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com