Provider Demographics
NPI:1215013065
Name:JASPER GENERAL HOSPITAL
Entity Type:Organization
Organization Name:JASPER GENERAL HOSPITAL
Other - Org Name:JASPER GENERAL HOSPITAL SWINGBED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:POSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-764-2101
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:601-764-2101
Mailing Address - Fax:601-764-2930
Practice Address - Street 1:15A SOUTH 6TH STREET
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:601-764-2101
Practice Address - Fax:601-764-2930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11226275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5000396OtherUNITED HEALTH CARE
MS000080009OtherBLUE CROSS BLUE SHIELD
MS00029160Medicaid
MS25U018Medicare ID - Type Unspecified