Provider Demographics
NPI:1184679292
Name:SOUTH SUNFLOWER COUNTY HOSPITAL
Entity Type:Organization
Organization Name:SOUTH SUNFLOWER COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-887-5235
Mailing Address - Street 1:121 EAST BAKER STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2450
Mailing Address - Country:US
Mailing Address - Phone:662-887-5235
Mailing Address - Fax:662-887-4111
Practice Address - Street 1:121 E BAKER ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2450
Practice Address - Country:US
Practice Address - Phone:662-887-5235
Practice Address - Fax:662-887-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020032Medicaid
MS000020032OtherBLUE CROSS
250095Medicare ID - Type Unspecified
=========OtherTRICARE