Provider Demographics
NPI:1770660920
Name:JASPER GENERAL HOSPITAL
Entity type:Organization
Organization Name:JASPER GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
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 1:20 S SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-9055
Mailing Address - Country:US
Mailing Address - Phone:601-764-4494
Mailing Address - Fax:601-764-4649
Practice Address - Street 1:20 S SIXTH ST
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9055
Practice Address - Country:US
Practice Address - Phone:601-764-4494
Practice Address - Fax:601-764-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00115455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09010972Medicaid
MS04-30099OtherUNITED HEALTH CARE
MS425136982BOtherBLUE CROSS
MS80088201OtherMEDICARE RAILROAD
MS425136982BOtherBLUE CROSS
MS09010972Medicaid