Healthcare Provider Details

I. General information

NPI: 1619095742
Provider Name (Legal Business Name): MONTFORT JONES MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HIGHWAY 12 W
KOSCIUSKO MS
39090-3208
US

IV. Provider business mailing address

220 HWY 12 W
KOSCIUSKO MS
39090
US

V. Phone/Fax

Practice location:
  • Phone: 662-390-3326
  • Fax:
Mailing address:
  • Phone: 662-289-4311
  • Fax: 662-290-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number11-008
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number11-008
License Number StateMS

VIII. Authorized Official

Name: MR. JOHN DAWSON
Title or Position: C.E.O.
Credential:
Phone: 662-289-4311