Provider Demographics
NPI:1568562676
Name:JASPER GENERAL HOSPITAL
Entity Type:Organization
Organization Name:JASPER GENERAL HOSPITAL
Other - Org Name:JASPER GENERAL HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-764-2101
Mailing Address - Street 1:15 A S SIXTH ST
Mailing Address - Street 2:PO BOX 527
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422
Mailing Address - Country:US
Mailing Address - Phone:601-764-2101
Mailing Address - Fax:601-764-4789
Practice Address - Street 1:15A SOUTH SIXTH STREET
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-0527
Practice Address - Country:US
Practice Address - Phone:601-764-2101
Practice Address - Fax:601-764-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MS010333.13336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043771OtherPK
MS00093319Medicaid