Provider Demographics
NPI:1457477135
Name:OKTIBBEHA COUNTY HOSPITAL NEUROLOGY
Entity Type:Organization
Organization Name:OKTIBBEHA COUNTY HOSPITAL NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-615-2503
Mailing Address - Street 1:400 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2163
Mailing Address - Country:US
Mailing Address - Phone:662-615-2503
Mailing Address - Fax:662-615-2554
Practice Address - Street 1:400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2163
Practice Address - Country:US
Practice Address - Phone:662-615-2503
Practice Address - Fax:662-615-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-2692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05634321Medicaid
MSC00688Medicare ID - Type UnspecifiedOCH NEUROLOGY GROUP