Provider Demographics
NPI:1497003610
Name:CLAIBORNE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CLAIBORNE COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:601-437-5141
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-1004
Mailing Address - Country:US
Mailing Address - Phone:601-437-5141
Mailing Address - Fax:
Practice Address - Street 1:123 MCCOMB AVE
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2915
Practice Address - Country:US
Practice Address - Phone:601-437-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21-276282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access