Provider Demographics
NPI:1255649604
Name:WALTHALL GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WALTHALL GENERAL HOSPITAL
Other - Org Name:WALTHALL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-4225
Mailing Address - Street 1:PO BOX 15722
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5722
Mailing Address - Country:US
Mailing Address - Phone:601-288-4338
Mailing Address - Fax:601-288-4360
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667
Practice Address - Country:US
Practice Address - Phone:601-876-2122
Practice Address - Fax:601-222-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
MS11-257282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25Z324Medicare Oscar/Certification