Provider Demographics
NPI:1477601177
Name:FORREST COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:FORREST COUNTY GENERAL HOSPITAL
Other - Org Name:FGH ANATOMIC PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-1050
Mailing Address - Street 1:300 S 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7127
Mailing Address - Country:US
Mailing Address - Phone:601-288-1050
Mailing Address - Fax:
Practice Address - Street 1:300 S 29TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7127
Practice Address - Country:US
Practice Address - Phone:601-288-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02165Medicare ID - Type Unspecified