1437470622 NPI number — FORREST COUNTY GENERAL HOSPITAL

Table of content: (NPI 1437470622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437470622 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:
PERRY COUNTY GENERAL HOSPITAL, CAH
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:
1437470622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/22/2020
NPI Reactivation Date:
02/12/2021

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:
39404-5722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-288-4338
Provider Business Mailing Address Fax Number:
601-288-4360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 BAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39476-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-788-6316
Provider Business Practice Location Address Fax Number:
601-788-2268
Provider Enumeration Date:
06/22/2010

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:  12-234 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 12-234 , 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: 009013542 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 193200000X , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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