Provider Demographics
NPI:1114951324
Name:PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC
Entity Type:Organization
Organization Name:PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC
Other - Org Name:RURAL HEALTHCARE DEVELOPERS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELSTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-840-0196
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-0510
Mailing Address - Country:US
Mailing Address - Phone:662-247-3831
Mailing Address - Fax:662-247-4114
Practice Address - Street 1:500 C C RD
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3806
Practice Address - Country:US
Practice Address - Phone:662-247-3831
Practice Address - Fax:662-247-4114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTHCARE DEVELOPERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21-169282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000019124OtherBLUE CROSS PHY PROV NUMBE
MS000020124OtherBLUE CROSS OF MS HOSP PRO
MS00020124Medicaid
MS000019124OtherBLUE CROSS PHY PROV NUMBE