Provider Demographics
NPI:1235382409
Name:SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:KEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-873-4395
Mailing Address - Street 1:47 S FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLING FORK
Mailing Address - State:MS
Mailing Address - Zip Code:39159-5146
Mailing Address - Country:US
Mailing Address - Phone:662-873-4395
Mailing Address - Fax:
Practice Address - Street 1:47 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:ROLLING FORK
Practice Address - State:MS
Practice Address - Zip Code:39159-5146
Practice Address - Country:US
Practice Address - Phone:662-873-4395
Practice Address - Fax:662-873-5188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21-172282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25Z338OtherMEDICARE PTAN
MS000029129Medicaid