Healthcare Provider Details

I. General information

NPI: 1639236383
Provider Name (Legal Business Name): YALOBUSHA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14430 MAIN ST
COFFEEVILLE MS
38922-2590
US

IV. Provider business mailing address

14430 MAIN ST
COFFEEVILLE MS
38922-2590
US

V. Phone/Fax

Practice location:
  • Phone: 662-675-2500
  • Fax: 662-675-2501
Mailing address:
  • Phone: 662-675-2500
  • Fax: 662-675-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRY L VARNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-473-1411