Healthcare Provider Details

I. General information

NPI: 1770941445
Provider Name (Legal Business Name): QUITMAN COUNTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 MARTIN LUTHER KING DR
MARKS MS
38646-1832
US

IV. Provider business mailing address

1024 MARTIN LUTHER KING DR
MARKS MS
38646-1832
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-3502
  • Fax: 662-326-2555
Mailing address:
  • Phone: 662-326-3502
  • Fax: 662-326-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY J GERACI
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-326-8031