Provider Demographics
NPI:1750486007
Name:WEBSTER HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:WEBSTER HEALTH SERVICES, INC.
Other - Org Name:WEBSTER GENERAL HOSPITAL SWING BED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:REPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-3978
Mailing Address - Street 1:70 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744-4018
Mailing Address - Country:US
Mailing Address - Phone:662-258-9341
Mailing Address - Fax:662-258-9291
Practice Address - Street 1:70 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744-4018
Practice Address - Country:US
Practice Address - Phone:662-258-9341
Practice Address - Fax:662-258-9291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEBSTER HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-225275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000080554OtherBLUE CROSS BLUE SHIELD OF MISSISSIPPI
MS000080010OtherBLUE CROSS / BLUE SHIELD OF MISSISSIPPI
MS0029178Medicaid
MS000080010OtherBLUE CROSS / BLUE SHIELD OF MISSISSIPPI