Provider Demographics
NPI:1750517009
Name:NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Entity type:Organization
Organization Name:NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-726-4231
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341
Mailing Address - Country:US
Mailing Address - Phone:662-738-5041
Mailing Address - Fax:662-738-5043
Practice Address - Street 1:1556 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39739-4003
Practice Address - Country:US
Practice Address - Phone:662-738-5041
Practice Address - Fax:662-738-5043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-01
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS061580113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120473OtherPK
MS06689871Medicaid