Provider Demographics
NPI:1932591468
Name:TALLAHATCHIE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:TALLAHATCHIE GENERAL HOSPITAL
Other - Org Name:HOLCOMB CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:VEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-625-7111
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-0240
Mailing Address - Country:US
Mailing Address - Phone:662-647-5535
Mailing Address - Fax:662-647-8432
Practice Address - Street 1:1301 SUNSET DR STE E
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4103
Practice Address - Country:US
Practice Address - Phone:662-229-9787
Practice Address - Fax:662-229-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05820575Medicaid
MS258601Medicare Oscar/Certification
MS05820575Medicaid