Provider Demographics
NPI:1528376217
Name:PEARL RIVER COUNTY HOSPITAL EMERGENCY DEPARTMENT
Entity Type:Organization
Organization Name:PEARL RIVER COUNTY HOSPITAL EMERGENCY DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEWARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-795-4543
Mailing Address - Street 1:305 W MOODY ST
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-7338
Mailing Address - Country:US
Mailing Address - Phone:601-795-4543
Mailing Address - Fax:601-795-4238
Practice Address - Street 1:305 W MOODY ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-7338
Practice Address - Country:US
Practice Address - Phone:601-795-4543
Practice Address - Fax:601-795-4238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARL RIVER COUNTY HOSPITAL AND NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21087282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital