Healthcare Provider Details

I. General information

NPI: 1043051543
Provider Name (Legal Business Name): COVINGTON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 MAGNOLIA DR
RALEIGH MS
39153-6011
US

IV. Provider business mailing address

PO BOX 2499
COLLINS MS
39428-2499
US

V. Phone/Fax

Practice location:
  • Phone: 601-698-0328
  • Fax: 601-698-0112
Mailing address:
  • Phone: 601-765-6711
  • Fax: 601-698-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ANISSA L PROMISE
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 601-698-0328