Provider Demographics
NPI:1992706303
Name:TALLAHATCHIE GENERAL HOSPITAL
Entity type:Organization
Organization Name:TALLAHATCHIE GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
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 2:141 DR. TT LEWIS CIRCLE
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:662-647-3677
Practice Address - Street 1:141 DR. T T LEWIS CIRCLE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2236
Practice Address - Country:US
Practice Address - Phone:662-647-5535
Practice Address - Fax:662-647-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-211275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25Z304Medicare Oscar/Certification