Provider Demographics
NPI:1629403480
Name:FORREST COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:FORREST COUNTY GENERAL HOSPITAL
Other - Org Name:OB-GYN GROUP - FORREST HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-2892
Mailing Address - Street 1:PO BOX 16389
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LINCOLN PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3262
Practice Address - Country:US
Practice Address - Phone:601-288-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORREST COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-11
Last Update Date:2016-11-30
Deactivation Date:2015-03-17
Deactivation Code:
Reactivation Date:2016-11-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty