Provider Demographics
NPI:1790872018
Name:NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Entity Type:Organization
Organization Name:NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Other - Org Name:MACON PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-726-4231
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-0480
Mailing Address - Country:US
Mailing Address - Phone:662-726-4264
Mailing Address - Fax:662-726-4204
Practice Address - Street 1:606 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-0480
Practice Address - Country:US
Practice Address - Phone:662-726-4264
Practice Address - Fax:662-726-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014786Medicaid
MSC02373Medicare ID - Type Unspecified
MS09014786Medicaid