Provider Demographics
NPI:1275621211
Name:NESHOBA COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:NESHOBA COUNTY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:601-656-1001
Mailing Address - Street 1:1122 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2348
Mailing Address - Country:US
Mailing Address - Phone:601-656-1001
Mailing Address - Fax:601-656-7555
Practice Address - Street 1:1122 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2348
Practice Address - Country:US
Practice Address - Phone:601-656-1001
Practice Address - Fax:601-656-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00218047OtherRAILROAD MEDICARE
MSP00218048OtherRAILROAD MEDICARE
MS06074366Medicaid
MSP00218048OtherRAILROAD MEDICARE