Healthcare Provider Details

I. General information

NPI: 1245512417
Provider Name (Legal Business Name): WALTHALL GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DRIVE
TYLERTOWN MS
39667
US

IV. Provider business mailing address

PO BOX 15722
HATTIESBURG MS
39404
US

V. Phone/Fax

Practice location:
  • Phone: 601-876-2122
  • Fax: 601-876-0432
Mailing address:
  • Phone: 601-288-1889
  • Fax: 601-288-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number11-257
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11-257
License Number StateMS

VIII. Authorized Official

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