Healthcare Provider Details

I. General information

NPI: 1598887705
Provider Name (Legal Business Name): COVINGTON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

IV. Provider business mailing address

PO BOX 1149
COLLINS MS
39428-1149
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-6711
  • Fax: 601-698-0180
Mailing address:
  • Phone: 601-765-6711
  • Fax: 601-698-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. BOBBY GRUBBS
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-765-6711