Provider Demographics
NPI:1417132044
Name:BATESVILLE HOSPITAL MANAGEMENT
Entity Type:Organization
Organization Name:BATESVILLE HOSPITAL MANAGEMENT
Other - Org Name:CORKERN FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORKERN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-572-0386
Mailing Address - Street 1:154 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 EUREKA ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2533
Practice Address - Country:US
Practice Address - Phone:601-573-0386
Practice Address - Fax:601-856-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12101261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0110277Medicaid
MS0110277Medicaid