Healthcare Provider Details

I. General information

NPI: 1003946138
Provider Name (Legal Business Name): NESHOBA COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HOLLAND AVE
PHILADELPHIA MS
39350-2161
US

IV. Provider business mailing address

PO BOX 648
PHILADELPHIA MS
39350-0648
US

V. Phone/Fax

Practice location:
  • Phone: 601-663-1200
  • Fax: 601-663-1379
Mailing address:
  • Phone: 601-663-1200
  • Fax: 601-663-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number11227
License Number StateMS

VIII. Authorized Official

Name: MR. SCOTT MCNAIR
Title or Position: CFO
Credential:
Phone: 601-663-1233