Provider Demographics
NPI:1649503699
Name:FRANKLIN COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:FRANKLIN COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEWARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-384-5801
Mailing Address - Street 1:P.O. BOX 636
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653
Mailing Address - Country:US
Mailing Address - Phone:601-384-5801
Mailing Address - Fax:601-384-4100
Practice Address - Street 1:40 UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653-8336
Practice Address - Country:US
Practice Address - Phone:601-384-5801
Practice Address - Fax:601-384-4100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANKLIN COUONTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-09
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11175275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000080019OtherBLUE CROSS BLUE SHIELD
MS00029130Medicaid
MS25Z330Medicare Oscar/Certification