Provider Demographics
NPI:1902844194
Name:NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Entity Type:Organization
Organization Name:NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
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:662-726-4231
Mailing Address - Fax:662-726-5784
Practice Address - Street 1:606 NORTH JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341
Practice Address - Country:US
Practice Address - Phone:662-726-4231
Practice Address - Fax:662-726-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-081282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020041Medicaid
MS09012439Medicaid
MS00029041Medicaid
MS25Z307Medicare Oscar/Certification
MSC00947Medicare ID - Type UnspecifiedCAHABA
MSCC7521Medicare ID - Type UnspecifiedPALMETTO GBA
MS251307Medicare Oscar/Certification