Provider Demographics
NPI:1184356602
Name:QUITMAN COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:QUITMAN COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-934-3900
Mailing Address - Street 1:340 GETWELL ST
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-9785
Mailing Address - Country:US
Mailing Address - Phone:662-388-0700
Mailing Address - Fax:662-388-0707
Practice Address - Street 1:340 GETWELL ST
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-9785
Practice Address - Country:US
Practice Address - Phone:662-388-0700
Practice Address - Fax:662-388-0707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUITMAN COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-24
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02755745Medicaid