Provider Demographics
NPI:1194860502
Name:TALLAHATCHIE GENERAL HOSPITAL
Entity type:Organization
Organization Name:TALLAHATCHIE GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:DOVER
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-625-7176
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-0240
Mailing Address - Country:US
Mailing Address - Phone:662-647-5535
Mailing Address - Fax:662-647-8432
Practice Address - Street 1:171 DR. T T LEWIS CIRCLE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2257
Practice Address - Country:US
Practice Address - Phone:662-647-5535
Practice Address - Fax:662-647-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014008Medicaid
MS=========OtherBLUE CROSS
MS=========OtherSTATE OF MS
MS=========OtherSTATE OF MS