Healthcare Provider Details

I. General information

NPI: 1851013353
Provider Name (Legal Business Name): SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S FOURTH ST
ROLLING FORK MS
39159-5146
US

IV. Provider business mailing address

PO BOX 339
ROLLING FORK MS
39159-0339
US

V. Phone/Fax

Practice location:
  • Phone: 662-873-5222
  • Fax:
Mailing address:
  • Phone: 662-873-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH J RODGERS
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 662-873-5174