Provider Demographics
NPI:1770574048
Name:FIELD MEMORIAL COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:FIELD MEMORIAL COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:NETTERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-890-0545
Mailing Address - Street 1:178 HIGHWAY 24 E
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-4171
Mailing Address - Country:US
Mailing Address - Phone:601-890-0500
Mailing Address - Fax:601-645-5873
Practice Address - Street 1:178 HIGHWAY 24 E
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4171
Practice Address - Country:US
Practice Address - Phone:601-890-0500
Practice Address - Fax:601-645-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11121282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020012Medicaid
MS09013134Medicaid
MS09013136Medicaid
MS09013135Medicaid
MS09013137Medicaid
MS09013289Medicaid
MS00029002Medicaid
LA1730955OtherMEDICAID
MS09013138Medicaid
LA1798126OtherMEDICAID
MS00020012Medicaid
MS09013134Medicaid
MS09013135Medicaid
C01085Medicare ID - Type Unspecified
MS251309Medicare ID - Type Unspecified
MS09013136Medicaid
MS00029002Medicaid
MS09013138Medicaid
C01083Medicare ID - Type Unspecified
25Z309Medicare ID - Type Unspecified