Healthcare Provider Details

I. General information

NPI: 1245248699
Provider Name (Legal Business Name): SOUTH SUNFLOWER COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E BAKER ST
INDIANOLA MS
38751-2451
US

IV. Provider business mailing address

122 E BAKER ST
INDIANOLA MS
38751-2451
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-2212
  • Fax: 662-887-1279
Mailing address:
  • Phone: 662-887-2212
  • Fax: 662-887-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. JIM WOODS
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 662-887-2212