Provider Demographics
NPI:1568040517
Name:TALLAHATCHIE GENERAL HOSPITAL MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:TALLAHATCHIE GENERAL HOSPITAL MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:MORING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD RDN CDCES BCADM
Authorized Official - Phone:501-276-5459
Mailing Address - Street 1:188 HONEYSUCKLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921
Mailing Address - Country:US
Mailing Address - Phone:501-276-5459
Mailing Address - Fax:662-625-3024
Practice Address - Street 1:188 HONEYSUCKLE DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921
Practice Address - Country:US
Practice Address - Phone:501-276-5459
Practice Address - Fax:662-625-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty