Provider Demographics
NPI:1740380914
Name:YALOBUSHA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:YALOBUSHA GENERAL HOSPITAL
Other - Org Name:YALOBUSHA GENERAL HOSPITAL PROF FEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-473-1411
Mailing Address - Street 1:630 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-3468
Mailing Address - Country:US
Mailing Address - Phone:662-473-1403
Mailing Address - Fax:662-473-4922
Practice Address - Street 1:630 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-3468
Practice Address - Country:US
Practice Address - Phone:662-473-1403
Practice Address - Fax:662-473-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-223282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000020175OtherBCBS HOSPITAL
MSDF8375OtherRR MEDICARE PROFESSIONAL
MSDZ0522OtherRR MEDICARE PROFESSIONAL
MS654763OtherPROFESSIONAL FEES
MSCG7236OtherRR MEDICARE PROFESSIONAL
MSDZ0522OtherRR MEDICARE PROFESSIONAL FEES
MS000019175OtherBCBS PROFESSIONAL
MS00553961Medicaid
MS654763OtherMEDICARE PROFESSIONAL FEES