Healthcare Provider Details

I. General information

NPI: 1083715718
Provider Name (Legal Business Name): JASPER GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BAY AVE
BAY SPRINGS MS
39422-0527
US

IV. Provider business mailing address

PO BOX 527
BAY SPRINGS MS
39422-0527
US

V. Phone/Fax

Practice location:
  • Phone: 601-764-2081
  • Fax: 601-764-9454
Mailing address:
  • Phone: 601-764-2081
  • Fax: 601-764-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5181
License Number StateMS

VIII. Authorized Official

Name: MRS. TERRI J JAMES
Title or Position: BILLING
Credential: R.N.
Phone: 601-764-2081