Provider Demographics
NPI:1396730164
Name:JASPER GENERAL HOSPITAL
Entity type:Organization
Organization Name:JASPER GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:POSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-764-2101
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-0527
Mailing Address - Country:US
Mailing Address - Phone:601-764-2101
Mailing Address - Fax:601-764-2930
Practice Address - Street 1:15 A SOUTH 6TH ST
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422
Practice Address - Country:US
Practice Address - Phone:601-764-2101
Practice Address - Fax:601-764-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11226282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00070596Medicaid
MS00020083Medicaid
MS00020177Medicaid
MS20177OtherJASPER GENERAL HOSP
MS000080009OtherJASPER GENERAL HOSPITAL
MS09010972Medicaid
MS29160Medicaid
MS00770340Medicaid
MS0430099OtherJASPER GENERAL HOSPITAL
MS70596OtherPROCARE HOME HEALTH
MS00020083Medicaid
MS25U018Medicare Oscar/Certification
MS250018Medicare Oscar/Certification
MS0430099OtherJASPER GENERAL HOSPITAL
MS257096Medicare ID - Type UnspecifiedPROCARE HOME HEALTH
MS00070596Medicaid