Provider Demographics
NPI:1982864526
Name:FORREST COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:FORREST COUNTY GENERAL HOSPITAL
Other - Org Name:PERRY COUNTY GENERAL HOSPITAL SNF
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-4225
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39215-1728
Mailing Address - Country:US
Mailing Address - Phone:601-288-4338
Mailing Address - Fax:601-288-4360
Practice Address - Street 1:206 BAY STREET
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-1665
Practice Address - Country:US
Practice Address - Phone:601-788-6316
Practice Address - Fax:601-788-2268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORREST COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-16
Last Update Date:2022-05-16
Deactivation Date:2020-01-22
Deactivation Code:
Reactivation Date:2020-02-04
Provider Licenses
StateLicense IDTaxonomies
MS12-234275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00029191Medicaid
MS275N00000XMedicare Oscar/Certification
MS00029191Medicaid