Healthcare Provider Details

I. General information

NPI: 1821420936
Provider Name (Legal Business Name): SOUTH SUNFLOWER COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

110 E BAKER ST
INDIANOLA MS
38751-2451
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-7339
  • Fax: 662-887-3920
Mailing address:
  • Phone: 662-887-5235
  • Fax: 662-887-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number11-102
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD JAMES BLESSITT
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-887-5235