Basic Information
Provider Information | |||||||||
NPI: | 1760789903 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FORREST COUNTY GENERAL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PEARL RIVER COUNTY HOSPITAL & NURSING HOME | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 125 S 28TH AVE STE 326 | ||||||||
Address2: |   | ||||||||
City: | HATTIESBURG | ||||||||
State: | MS | ||||||||
PostalCode: | 394017152 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6012881823 | ||||||||
FaxNumber: | 6012884360 | ||||||||
Practice Location | |||||||||
Address1: | 305 W MOODY ST | ||||||||
Address2: |   | ||||||||
City: | POPLARVILLE | ||||||||
State: | MS | ||||||||
PostalCode: | 394707338 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6017954543 | ||||||||
FaxNumber: | 6017954238 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/24/2011 | ||||||||
LastUpdateDate: | 04/16/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HESTER | ||||||||
AuthorizedOfficialFirstName: | BEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 6012884225 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | FORREST COUNTY GENERAL HOSPITAL | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/16/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 21-087 | MS | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.