Provider Demographics
NPI:1043230923
Name:QUITMAN COUNTY HOSPITAL, LLC
Entity Type:Organization
Organization Name:QUITMAN COUNTY HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-326-8031
Mailing Address - Street 1:340 GETWELL ST
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-9785
Mailing Address - Country:US
Mailing Address - Phone:662-326-8031
Mailing Address - Fax:662-326-8478
Practice Address - Street 1:340 GETWELL ST
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-9785
Practice Address - Country:US
Practice Address - Phone:662-326-8031
Practice Address - Fax:662-326-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-291275N00000X
MS16291282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000080725OtherBLUE CROSS/BLUE SHIELD
MS05854578Medicaid
MS25Z314Medicare ID - Type Unspecified