Healthcare Provider Details

I. General information

NPI: 1255547618
Provider Name (Legal Business Name): MADISON COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 E PEACE ST
CANTON MS
39046-4938
US

IV. Provider business mailing address

1421 E PEACE ST
CANTON MS
39046-4938
US

V. Phone/Fax

Practice location:
  • Phone: 601-855-5771
  • Fax: 601-855-5781
Mailing address:
  • Phone: 601-855-5771
  • Fax: 601-855-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LOGAN
Title or Position: MANAGAER
Credential:
Phone: 601-855-5771