Healthcare Provider Details

I. General information

NPI: 1477876274
Provider Name (Legal Business Name): HARDY WILSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
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: 601-894-6211
  • Fax:
Mailing address:
  • Phone: 601-894-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number11-164
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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