Provider Demographics
NPI:1477876274
Name:HARDY WILSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HARDY WILSON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-894-4541
Mailing Address - Street 1:233 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2228
Mailing Address - Country:US
Mailing Address - Phone:601-894-6211
Mailing Address - Fax:
Practice Address - Street 1:233 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2228
Practice Address - Country:US
Practice Address - Phone:601-894-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-164282NC0060X
367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013467Medicaid