Healthcare Provider Details

I. General information

NPI: 1124341441
Provider Name (Legal Business Name): HARDY WILSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAGNOLIA ST
HAZLEHURST MS
39083-2228
US

IV. Provider business mailing address

233 MAGNOLIA ST
HAZLEHURST MS
39083-2228
US

V. Phone/Fax

Practice location:
  • Phone: 601-894-4541
  • Fax: 601-894-6279
Mailing address:
  • Phone: 601-894-4541
  • Fax: 601-894-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ANN S BERCH
Title or Position: CFO
Credential:
Phone: 601-894-4541