Provider Demographics
NPI:1518374875
Name:CHOCTAW REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CHOCTAW REGIONAL MEDICAL CENTER
Other - Org Name:CHOCTAW NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHANCERY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-285-6329
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-0719
Mailing Address - Country:US
Mailing Address - Phone:662-285-6235
Mailing Address - Fax:
Practice Address - Street 1:311 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-8708
Practice Address - Country:US
Practice Address - Phone:662-285-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01809271Medicaid