Provider Demographics
NPI:1437470622
Name:FORREST COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:FORREST COUNTY GENERAL HOSPITAL
Other - Org Name:PERRY COUNTY GENERAL HOSPITAL, CAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-4225
Mailing Address - Street 1:PO BOX 15722
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5722
Mailing Address - Country:US
Mailing Address - Phone:601-288-4338
Mailing Address - Fax:601-288-4360
Practice Address - Street 1:206 BAY AVE
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-2941
Practice Address - Country:US
Practice Address - Phone:601-788-6316
Practice Address - Fax:601-788-2268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORREST COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-22
Last Update Date:2022-11-08
Deactivation Date:2020-01-22
Deactivation Code:
Reactivation Date:2021-02-12
Provider Licenses
StateLicense IDTaxonomies
MS12-234282NC0060X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009013542Medicaid
MS193200000XMedicaid
MS09013542Medicaid