Provider Demographics
NPI:1134166812
Name:FIELD MEMORIAL COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:FIELD MEMORIAL COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:NETTERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-890-0545
Mailing Address - Street 1:178 HIGHWAY 24 E STE A
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-4171
Mailing Address - Country:US
Mailing Address - Phone:601-890-0520
Mailing Address - Fax:601-645-5088
Practice Address - Street 1:178 HIGHWAY 24 E STE A
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4171
Practice Address - Country:US
Practice Address - Phone:601-890-0520
Practice Address - Fax:601-645-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02787OtherCAHABA
MS09016302Medicaid
LA1444669Medicaid
MS09016302Medicaid
LA1444669Medicaid