Provider Demographics
NPI:1518149723
Name:UNIV HOSPITAL HOLMES COUNTY
Entity Type:Organization
Organization Name:UNIV HOSPITAL HOLMES COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEWERY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-834-1321
Mailing Address - Street 1:239 BOWLING GREEN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-5167
Mailing Address - Country:US
Mailing Address - Phone:662-834-1321
Mailing Address - Fax:662-834-5141
Practice Address - Street 1:239 BOWLING GREEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-5167
Practice Address - Country:US
Practice Address - Phone:662-834-1321
Practice Address - Fax:662-834-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-199-S-2261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS19838OtherBLUE CROSS
258513OtherMEDICARE
MS6300013Medicaid