Provider Demographics
NPI:1083637904
Name:MARION GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MARION GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-740-2190
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-0630
Mailing Address - Country:US
Mailing Address - Phone:601-736-6303
Mailing Address - Fax:601-740-2244
Practice Address - Street 1:1560 SUMRALL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2654
Practice Address - Country:US
Practice Address - Phone:601-736-6303
Practice Address - Fax:601-740-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11167282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020116Medicaid
LA1731595Medicaid
MS000020116OtherBLUE CROSS
LA1731595Medicaid