Healthcare Provider Details

I. General information

NPI: 1356460869
Provider Name (Legal Business Name): HUMPHREYS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/25/2010
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 Code282NC0060X
TaxonomyCritical Access Hospital
License Number21169
License Number StateMS

VIII. Authorized Official

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