Provider Demographics
NPI:1619567203
Name:FORREST HEALTH SYSTEM
Entity Type:Organization
Organization Name:FORREST HEALTH SYSTEM
Other - Org Name:FORREST GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIMARY PHYSICIAN
Authorized Official - Prefix:PROF
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DO RN
Authorized Official - Phone:601-288-7000
Mailing Address - Street 1:6501 U S HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3006
Mailing Address - Country:US
Mailing Address - Phone:601-288-7000
Mailing Address - Fax:
Practice Address - Street 1:513 BROOKWOOD BLVD STE 506
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6892
Practice Address - Country:US
Practice Address - Phone:877-977-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIT HEALTH WESLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-19
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Single Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251V00000XAgenciesVoluntary or Charitable
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No291U00000XLaboratoriesClinical Medical Laboratory
No293D00000XLaboratoriesPhysiological Laboratory
No305S00000XManaged Care OrganizationsPoint of Service
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS851575OtherHEALTHCARE PROVIDER
MSMS41120OtherSTATE MEDICAL LICENSE