Provider Demographics
NPI:1578706107
Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type:Organization
Organization Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Other - Org Name:GREAT RIVER MEDICAL CENTER-PRO FEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-838-7445
Mailing Address - Street 1:1520 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1448
Mailing Address - Country:US
Mailing Address - Phone:870-838-7445
Mailing Address - Fax:870-838-7492
Practice Address - Street 1:1520 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1448
Practice Address - Country:US
Practice Address - Phone:870-838-7445
Practice Address - Fax:870-838-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital