Healthcare Provider Details

I. General information

NPI: 1629107990
Provider Name (Legal Business Name): PRENTISS REGIONAL HOSPITAL AND ECF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ROSE STREET
PRENTISS MS
39474
US

IV. Provider business mailing address

PO BOX 1288
PRENTISS MS
39474-1288
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 Number16-179
License Number StateMS

VIII. Authorized Official

Name: GARY LEE MCCALL JR.
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 601-792-4276