Provider Demographics
NPI:1417969700
Name:SOUTH PIKE HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:SOUTH PIKE HOSPITAL ASSOCIATION, INC.
Other - Org Name:BEACHAM MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-783-2353
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-0351
Mailing Address - Country:US
Mailing Address - Phone:601-783-2353
Mailing Address - Fax:601-783-9003
Practice Address - Street 1:205 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2819
Practice Address - Country:US
Practice Address - Phone:601-783-2353
Practice Address - Fax:601-783-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-275282N00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020043Medicaid
MS000020043OtherBLUE CROSS
MS000080027OtherBLUE CROSS
MS000020043OtherBLUE CROSS
250049Medicare ID - Type Unspecified