Provider Demographics
NPI:1003834979
Name:NESHOBA COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:NESHOBA COUNTY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-663-1360
Mailing Address - Street 1:213 HOSPITAL RD W
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2211
Mailing Address - Country:US
Mailing Address - Phone:601-663-1210
Mailing Address - Fax:601-663-1211
Practice Address - Street 1:213 HOSPITAL RD W
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2211
Practice Address - Country:US
Practice Address - Phone:601-663-1210
Practice Address - Fax:601-663-1211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NESHOBA COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS258559261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06322054Medicaid
MS07089504Medicaid
MS25-8559OtherMEDICARE PART A
MSC03442Medicare UPIN