Provider Demographics
NPI:1598887705
Name:COVINGTON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:COVINGTON COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-765-6711
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-1149
Mailing Address - Country:US
Mailing Address - Phone:601-765-6711
Mailing Address - Fax:601-698-0180
Practice Address - Street 1:701 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3894
Practice Address - Country:US
Practice Address - Phone:601-765-6711
Practice Address - Fax:601-698-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013281Medicaid