Provider Demographics
NPI:1083715718
Name:JASPER GENERAL HOSPITAL
Entity Type:Organization
Organization Name:JASPER GENERAL HOSPITAL
Other - Org Name:PRO CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-764-2081
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-0527
Mailing Address - Country:US
Mailing Address - Phone:601-764-2081
Mailing Address - Fax:601-764-9454
Practice Address - Street 1:20 BAY AVE
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-0527
Practice Address - Country:US
Practice Address - Phone:601-764-2081
Practice Address - Fax:601-764-9454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5181251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00070596Medicaid
MS862206OtherWELLCARE
MS5000396OtherUNITED HEALTH CARE
MS000070596OtherBLUE CROSS
MS257096Medicare PIN