Provider Demographics
NPI:1083659734
Name:NESHOBA COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:NESHOBA COUNTY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-663-1230
Mailing Address - Street 1:1001 HOLLAND AVE
Mailing Address - Street 2:PO BOX 648
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2161
Mailing Address - Country:US
Mailing Address - Phone:601-663-1200
Mailing Address - Fax:
Practice Address - Street 1:1001 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2161
Practice Address - Country:US
Practice Address - Phone:601-663-1200
Practice Address - Fax:601-663-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-227282N00000X
333600000X, 3336L0003X
MS008590313336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
000020181OtherBLUE CROSS
MS00020181Medicaid
2509694OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MS00037257Medicaid
MS00020181Medicaid
000020181OtherBLUE CROSS
=========001OtherTRICARE