Provider Demographics
NPI:1770941445
Name:QUITMAN COUNTY HOSPITAL, LLC
Entity type:Organization
Organization Name:QUITMAN COUNTY HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERACI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-326-8031
Mailing Address - Street 1:1024 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-1832
Mailing Address - Country:US
Mailing Address - Phone:662-326-3502
Mailing Address - Fax:662-326-2555
Practice Address - Street 1:1024 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-1832
Practice Address - Country:US
Practice Address - Phone:662-326-3502
Practice Address - Fax:662-326-2555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUITMAN COUNTY HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-09
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty