Provider Demographics
NPI:1013004795
Name:SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:KEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-873-4395
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ROLLING FORK
Mailing Address - State:MS
Mailing Address - Zip Code:39159-0339
Mailing Address - Country:US
Mailing Address - Phone:662-873-4395
Mailing Address - Fax:662-873-5188
Practice Address - Street 1:47 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:ROLLING FORK
Practice Address - State:MS
Practice Address - Zip Code:39159-5146
Practice Address - Country:US
Practice Address - Phone:662-873-4395
Practice Address - Fax:662-873-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21-172282N00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9013019Medicaid
MS9013018Medicaid
MS0020129Medicaid
MS20129OtherBLUE CROSS BLUE SHIELD
MS0050033Medicaid
MS0029129Medicaid
MS9013019Medicaid