Healthcare Provider Details

I. General information

NPI: 1417132044
Provider Name (Legal Business Name): BATESVILLE HOSPITAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EUREKA ST
BATESVILLE MS
38606-2533
US

IV. Provider business mailing address

154 OAKDALE RD
MADISON MS
39110-9076
US

V. Phone/Fax

Practice location:
  • Phone: 601-573-0386
  • Fax: 601-856-8003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number12101
License Number StateMS

VIII. Authorized Official

Name: MRS. MISSY CORKERN
Title or Position: VP
Credential: RN
Phone: 601-572-0386