Provider Demographics
NPI:1336256700
Name:FORREST COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:FORREST COUNTY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:RUSSUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-4344
Mailing Address - Street 1:1414 SOUTH 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-288-4344
Mailing Address - Fax:601-288-2401
Practice Address - Street 1:1414 SOUTH 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-288-4344
Practice Address - Fax:601-288-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4585251E00000X
MS008251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770033Medicaid
MS00070505Medicaid
MS00770033Medicaid
MS00070505Medicaid