Healthcare Provider Details

I. General information

NPI: 1831250075
Provider Name (Legal Business Name): GREENE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 JACKSON AVE
LEAKESVILLE MS
39451-9105
US

IV. Provider business mailing address

200 FOXGATE AVE APT 18B
HATTIESBURG MS
39402-1876
US

V. Phone/Fax

Practice location:
  • Phone: 601-394-4135
  • Fax:
Mailing address:
  • Phone: 601-325-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number09382
License Number StateMS

VIII. Authorized Official

Name: MRS. CIRILA L REYES
Title or Position: ER PHYSICIAN
Credential: M.D.
Phone: 601-394-4135