Provider Demographics
NPI:1992024558
Name:SOUTH PIKE HOSPITAL ASSOCIATION, INC
Entity Type:Organization
Organization Name:SOUTH PIKE HOSPITAL ASSOCIATION, INC
Other - Org Name:OSYKA FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-783-2353
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 1:1081 SECOND ST
Practice Address - Street 2:
Practice Address - City:OSYKA
Practice Address - State:MS
Practice Address - Zip Code:39657-8076
Practice Address - Country:US
Practice Address - Phone:601-542-3300
Practice Address - Fax:601-542-5999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH PIKE HOSPITAL ASSOCIATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-275261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health