Provider Demographics
NPI:1902401425
Name:SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Other - Org Name:SHARKEY ISSAQUENA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:KEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-873-4395
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ROLLING FORK
Mailing Address - State:MS
Mailing Address - Zip Code:39159-0339
Mailing Address - Country:US
Mailing Address - Phone:662-873-4395
Mailing Address - Fax:
Practice Address - Street 1:283 W RACE ST
Practice Address - Street 2:
Practice Address - City:ROLLING FORK
Practice Address - State:MS
Practice Address - Zip Code:39159-2621
Practice Address - Country:US
Practice Address - Phone:662-873-4395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health