Provider Demographics
NPI:1144204561
Name:KILMICHAEL HOSPITAL
Entity Type:Organization
Organization Name:KILMICHAEL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-262-4311
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:301 LAMAR AVENUE
Mailing Address - City:KILMICHAEL
Mailing Address - State:MS
Mailing Address - Zip Code:39747-0188
Mailing Address - Country:US
Mailing Address - Phone:662-262-4311
Mailing Address - Fax:662-262-5586
Practice Address - Street 1:301 LAMAR AVENUE
Practice Address - Street 2:
Practice Address - City:KILMICHAEL
Practice Address - State:MS
Practice Address - Zip Code:39747-0188
Practice Address - Country:US
Practice Address - Phone:662-262-4311
Practice Address - Fax:662-262-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21183282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020147OtherBLUE CROSS BLUE SHIELD MS
MS03335377Medicaid
MS00020147Medicaid
MS25U051Medicare Oscar/Certification
MSC00217Medicare Oscar/Certification
MS00020147Medicaid
MS25S051Medicare ID - Type UnspecifiedGERIPSY