Provider Demographics
NPI:1275667867
Name:MONTFORT JONES MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MONTFORT JONES MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-290-3304
Mailing Address - Street 1:220 HWY 12 W
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090
Mailing Address - Country:US
Mailing Address - Phone:662-290-3304
Mailing Address - Fax:662-290-3302
Practice Address - Street 1:220 HWY 12 W
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090
Practice Address - Country:US
Practice Address - Phone:662-290-3304
Practice Address - Fax:662-290-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-008273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25M336Medicare UPIN
MS25S059Medicare ID - Type UnspecifiedSENIOR CARE