Healthcare Provider Details

I. General information

NPI: 1689842999
Provider Name (Legal Business Name): HUMPHREYS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 C C RD
BELZONI MS
39038-3806
US

IV. Provider business mailing address

500 C C RD
BELZONI MS
39038-3806
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 Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. RAY SHOEMAKER
Title or Position: CEO
Credential:
Phone: 662-247-3831