Provider Demographics
NPI:1205811304
Name:NORTH OAK REGIONAL HOSPITAL INC
Entity type:Organization
Organization Name:NORTH OAK REGIONAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-562-3100
Mailing Address - Street 1:401 GETWELL DR
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2213
Mailing Address - Country:US
Mailing Address - Phone:662-562-3100
Mailing Address - Fax:662-560-6295
Practice Address - Street 1:401 GETWELL DR
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2213
Practice Address - Country:US
Practice Address - Phone:662-562-3100
Practice Address - Fax:662-560-6295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH OAK REGIONAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-12
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-286282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00220631Medicaid
MS00020227OtherBLUE CROSS PROVIDER #
MS00020227OtherBLUE CROSS PROVIDER #
MS25S126Medicare ID - Type UnspecifiedGERIATRIC PHYSC UNIT