Provider Demographics
NPI:1861650483
Name:STONE COUNTY HOSPITAL, INC.
Entity Type:Organization
Organization Name:STONE COUNTY HOSPITAL, INC.
Other - Org Name:STONE COUNTY FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-928-6620
Mailing Address - Street 1:1434 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-9602
Mailing Address - Country:US
Mailing Address - Phone:601-928-6600
Mailing Address - Fax:601-928-6658
Practice Address - Street 1:1434 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-9602
Practice Address - Country:US
Practice Address - Phone:601-928-6600
Practice Address - Fax:601-928-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12280261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS258519OtherTRISPAN RURAL HEALTH CLINIC