Healthcare Provider Details

I. General information

NPI: 1720253735
Provider Name (Legal Business Name): HUMPHREYS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CCC ROAD
BELZONI MS
39038-0000
US

IV. Provider business mailing address

PO BOX 510
BELZONI MS
39038-0510
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-3831
  • Fax: 662-247-4114
Mailing address:
  • Phone: 662-247-3831
  • Fax: 662-247-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAY SHOEMAKER
Title or Position: CEO
Credential:
Phone: 662-321-1155