Healthcare Provider Details

I. General information

NPI: 1568419166
Provider Name (Legal Business Name): QUITMAN COUNTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 GETWELL ST
MARKS MS
38646-9785
US

IV. Provider business mailing address

340 GETWELL ST
MARKS MS
38646-9785
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-8031
  • Fax: 662-326-8478
Mailing address:
  • Phone: 662-326-8031
  • Fax: 662-326-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number16-291
License Number StateMS

VIII. Authorized Official

Name: MRS. JANE MOORE
Title or Position: CFO
Credential:
Phone: 662-326-8031