Provider Demographics
NPI:1942501507
Name:FREEDOM HOSPITAL OF MAGNOLIA LLC
Entity Type:Organization
Organization Name:FREEDOM HOSPITAL OF MAGNOLIA LLC
Other - Org Name:BEACHAM MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-802-1336
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-0351
Mailing Address - Country:US
Mailing Address - Phone:601-783-2353
Mailing Address - Fax:601-783-9003
Practice Address - Street 1:205 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2819
Practice Address - Country:US
Practice Address - Phone:601-783-2353
Practice Address - Fax:601-783-9003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREEDOM HOSPITAL OF MAGNOLIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-12
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-275275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000080027OtherBLUE CROSS
MS250049Medicaid
00020043OtherBLUE CROSS
00020043OtherBLUE CROSS
MS250049Medicaid