Provider Demographics
NPI:1619008174
Name:FORREST COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:FORREST COUNTY GENERAL HOSPITAL
Other - Org Name:HIGHLAND INTERNAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PYLATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-1864
Mailing Address - Street 1:PO BOX 15722
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5722
Mailing Address - Country:US
Mailing Address - Phone:601-288-1823
Mailing Address - Fax:601-288-1877
Practice Address - Street 1:200 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426
Practice Address - Country:US
Practice Address - Phone:601-799-4777
Practice Address - Fax:601-799-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS110001530OtherMEDICARE INDIVIDUAL
LA1658723Medicaid
MS09520729Medicaid
P007466664OtherMEDICARE RAILROAD
MS110001530OtherMEDICARE INDIVIDUAL