Healthcare Provider Details

I. General information

NPI: 1023050564
Provider Name (Legal Business Name): SOUTH SUNFLOWER COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BAKER ST SUITE A
INDIANOLA MS
38751-2451
US

IV. Provider business mailing address

110 E BAKER ST SUITE A
INDIANOLA MS
38751-2451
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-7081
  • Fax: 662-887-3920
Mailing address:
  • Phone: 662-887-7081
  • Fax: 662-887-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11-1102
License Number StateMS

VIII. Authorized Official

Name: MR. HAROLD J BLESSITT
Title or Position: HOSPITAL ADMINISTRATOR
Credential:
Phone: 662-887-7081