Provider Demographics
NPI:1528295532
Name:NESHOBA COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:NESHOBA COUNTY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-663-1233
Mailing Address - Street 1:1120 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2300
Mailing Address - Country:US
Mailing Address - Phone:601-656-1465
Mailing Address - Fax:601-656-2752
Practice Address - Street 1:1120 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2300
Practice Address - Country:US
Practice Address - Phone:601-656-1465
Practice Address - Fax:601-656-2752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NESHOBA COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-17
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS258560261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07788305Medicaid
MS07788305Medicaid
MS258560Medicare Oscar/Certification
MS09014742Medicaid