Provider Demographics
NPI:1629235023
Name:COVINGTON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:COVINGTON COUNTY HOSPITAL
Other - Org Name:FAMILY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-423-0004
Mailing Address - Street 1:P.O. BOX 2499
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-2499
Mailing Address - Country:US
Mailing Address - Phone:601-765-3180
Mailing Address - Fax:601-765-2808
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:601-765-3180
Practice Address - Fax:601-765-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015963Medicaid
MSC02717Medicare PIN
MS253497Medicare Oscar/Certification