Healthcare Provider Details

I. General information

NPI: 1003194747
Provider Name (Legal Business Name): FORREST COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ROSE ST
PRENTISS MS
39474-5200
US

IV. Provider business mailing address

1102 ROSE ST
PRENTISS MS
39474-5200
US

V. Phone/Fax

Practice location:
  • Phone: 601-792-4276
  • Fax: 601-792-2947
Mailing address:
  • Phone: 601-792-4276
  • Fax: 601-792-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ANDREW WOODARD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 601-288-2892