1275700064 NPI number — FORREST COUNTY GENERAL HOSPITAL

Table of content: (NPI 1275700064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275700064 NPI number — FORREST COUNTY GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORREST COUNTY 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:
1275700064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 HIGHLAND PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICAYUNE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39466-5574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-358-9420
Provider Business Mailing Address Fax Number:
601-358-9421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 HIGHLAND PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICAYUNE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39466-5574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-358-9420
Provider Business Practice Location Address Fax Number:
601-358-9421
Provider Enumeration Date:
05/12/2008

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: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282E00000X , with the licence number: 11086 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 25U117 . This is a "MEDICARE PROVIDER NUMBER SWING" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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