Provider Demographics
NPI:1588667281
Name:COPIAH COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:COPIAH COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH INFORMATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-574-7255
Mailing Address - Street 1:27190 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2224
Mailing Address - Country:US
Mailing Address - Phone:601-574-7000
Mailing Address - Fax:601-574-7216
Practice Address - Street 1:27190 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2224
Practice Address - Country:US
Practice Address - Phone:601-574-7000
Practice Address - Fax:601-574-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-164282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013467Medicaid
MS00020115Medicaid
MS00050875Medicaid
MS00020115Medicaid
MS09013467Medicaid