Healthcare Provider Details

I. General information

NPI: 1003148859
Provider Name (Legal Business Name): FIELD MEMORIAL COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 N CAPTAIN GLOSTER DR
GLOSTER MS
39638-3401
US

IV. Provider business mailing address

270 W MAIN STREET
CENTREVILLE MS
39631
US

V. Phone/Fax

Practice location:
  • Phone: 601-224-4711
  • Fax:
Mailing address:
  • Phone: 601-645-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CHAD NETTERVILLE
Title or Position: CEO
Credential:
Phone: 601-645-5221