Provider Demographics
NPI:1871633347
Name:FIELD MEMORIAL COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:FIELD MEMORIAL COMMUNITY HOSPITAL
Other - Org Name:FIELD HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NETTERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-890-0545
Mailing Address - Street 1:178 HIGHWAY 24 E
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-4171
Mailing Address - Country:US
Mailing Address - Phone:601-890-0500
Mailing Address - Fax:601-645-5873
Practice Address - Street 1:178 HIGHWAY 24 E
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4171
Practice Address - Country:US
Practice Address - Phone:601-890-0500
Practice Address - Fax:601-645-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-121282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013137Medicaid
MS09013138Medicaid
MS09013134Medicaid
MS09013135Medicaid
MS09013289Medicaid
MSC00140Medicare ID - Type UnspecifiedER PHYSICIAN
MSC01085Medicare ID - Type UnspecifiedRADIOLOGY PHYSICIAN
MS09013289Medicaid