Provider Demographics
NPI:1205974201
Name:FORREST COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:FORREST COUNTY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-288-4225
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39215-1728
Mailing Address - Country:US
Mailing Address - Phone:601-288-4338
Mailing Address - Fax:601-288-4360
Practice Address - Street 1:210 BAY AVE
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-1237
Practice Address - Country:US
Practice Address - Phone:601-788-9222
Practice Address - Fax:601-788-6635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORREST COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014921Medicaid
253452Medicare UPIN
MS09014921Medicaid