Healthcare Provider Details

I. General information

NPI: 1760126106
Provider Name (Legal Business Name): COVINGTON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL BLVD
COLLINS MS
39428-4225
US

IV. Provider business mailing address

PO BOX 1149
COLLINS MS
39428-1149
US

V. Phone/Fax

Practice location:
  • Phone: 601-837-6628
  • Fax: 601-837-7379
Mailing address:
  • Phone: 601-765-2746
  • Fax: 601-765-6660

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