Provider Demographics
NPI:1740795806
Name:FORREST GENERAL HOSPITAL
Entity Type:Organization
Organization Name:FORREST GENERAL HOSPITAL
Other - Org Name:HOSPICE/HOMECARE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-4225
Mailing Address - Street 1:1414 SOUTH 28TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-288-2438
Mailing Address - Fax:601-288-2486
Practice Address - Street 1:1414 SOUTH 28TH AVENUE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-288-2438
Practice Address - Fax:601-288-2486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORREST GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04235.5.13336H0001X
MS042355.13336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy