Healthcare Provider Details

I. General information

NPI: 1831895911
Provider Name (Legal Business Name): COVINGTON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 S FIR AVE
COLLINS MS
39428-3809
US

IV. Provider business mailing address

PO BOX 2499
COLLINS MS
39428-2499
US

V. Phone/Fax

Practice location:
  • Phone: 601-698-0263
  • Fax:
Mailing address:
  • Phone: 601-765-2746
  • Fax: 601-640-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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