Healthcare Provider Details

I. General information

NPI: 1013004795
Provider Name (Legal Business Name): SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 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: 662-873-4395
  • Fax: 662-873-5188
Mailing address:
  • Phone: 662-873-4395
  • Fax: 662-873-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number21-172
License Number StateMS

VIII. Authorized Official

Name: MR. STEVEN GERALD KEEVER
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-873-4395