Provider Demographics
NPI:1467706762
Name:GREENE COUNTY CLINIC HOSPITAL SERVICES
Entity Type:Organization
Organization Name:GREENE COUNTY CLINIC HOSPITAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-947-1330
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-1007
Mailing Address - Country:US
Mailing Address - Phone:601-947-1330
Mailing Address - Fax:601-947-1331
Practice Address - Street 1:1017 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-9105
Practice Address - Country:US
Practice Address - Phone:601-947-8181
Practice Address - Fax:601-947-4411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE COUNTY FAMILY MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty