Healthcare Provider Details

I. General information

NPI: 1134799869
Provider Name (Legal Business Name): COVINGTON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

IV. Provider business mailing address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-6711
  • Fax: 601-698-0112
Mailing address:
  • Phone: 601-765-6711
  • Fax: 601-698-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANISSA L EVANS
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 601-698-0328