Healthcare Provider Details

I. General information

NPI: 1184679292
Provider Name (Legal Business Name): SOUTH SUNFLOWER COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E BAKER ST
INDIANOLA MS
38751-2450
US

IV. Provider business mailing address

121 EAST BAKER STREET
INDIANOLA MS
38751-2450
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-5235
  • Fax: 662-887-4111
Mailing address:
  • Phone: 662-887-5235
  • Fax: 662-887-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. COURTNEY R PHILLIPS
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-887-5235