Healthcare Provider Details

I. General information

NPI: 1366176836
Provider Name (Legal Business Name): RIVER OAKS HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 RIVER OAKS DR
FLOWOOD MS
39232-9553
US

IV. Provider business mailing address

1030 RIVER OAKS DR
FLOWOOD MS
39232-9553
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-1030
  • Fax: 601-936-2275
Mailing address:
  • Phone: 601-932-1030
  • Fax: 601-936-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: SR DIRECTOR
Credential:
Phone: 629-215-3953