Healthcare Provider Details

I. General information

NPI: 1568879864
Provider Name (Legal Business Name): CHOCTAW REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 MS HIGHWAY 12
ACKERMAN MS
39735-8917
US

IV. Provider business mailing address

PO BOX 719
ACKERMAN MS
39735-0719
US

V. Phone/Fax

Practice location:
  • Phone: 662-285-4400
  • Fax:
Mailing address:
  • Phone: 662-285-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HOLLINGSWORTH WELLS
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-285-9460