Provider Demographics
NPI:1386731636
Name:PHYSICIANS AND SURGEONS HOSPITAL GROUP
Entity type:Organization
Organization Name:PHYSICIANS AND SURGEONS HOSPITAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-563-5611
Mailing Address - Street 1:303 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606
Mailing Address - Country:US
Mailing Address - Phone:662-712-2377
Mailing Address - Fax:662-712-2481
Practice Address - Street 1:303 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-712-2377
Practice Address - Fax:662-712-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11287273R00000X, 275N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00029229Medicaid
MS00050874Medicaid
MS00020229Medicaid
MS00855504Medicaid
MS20229OtherBC
25A128Medicare ID - Type Unspecified
250128Medicare ID - Type Unspecified
MSC01050Medicare PIN
25S128Medicare ID - Type Unspecified
MS00020229Medicaid
MS00855504Medicaid