Healthcare Provider Details

I. General information

NPI: 1437470622
Provider Name (Legal Business Name): FORREST COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date: 01/22/2020
Reactivation Date: 02/12/2021

III. Provider practice location address

206 BAY AVE
RICHTON MS
39476-2941
US

IV. Provider business mailing address

PO BOX 15722
HATTIESBURG MS
39404-5722
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-6316
  • Fax: 601-788-2268
Mailing address:
  • Phone: 601-288-4338
  • Fax: 601-288-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number12-234
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12-234
License Number StateMS

VIII. Authorized Official

Name: BEN HESTER
Title or Position: CFO
Credential:
Phone: 601-288-4225