Provider Demographics
NPI:1275765828
Name:OCH GENERAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:OCH GENERAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-615-2500
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2570
Practice Address - Country:US
Practice Address - Phone:662-615-3781
Practice Address - Fax:662-615-3786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKTIBBEHA COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-17
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-269261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06985806Medicaid
MS06985806Medicaid