Healthcare Provider Details

I. General information

NPI: 1720383862
Provider Name (Legal Business Name): YALOBUSHA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S MAIN ST
WATER VALLEY MS
38965-3468
US

IV. Provider business mailing address

606 S MAIN ST
WATER VALLEY MS
38965-3468
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-5143
  • Fax: 662-473-4991
Mailing address:
  • Phone: 662-473-5143
  • Fax: 662-473-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1126
License Number StateMS

VIII. Authorized Official

Name: MS. VANESSA LIVINGSTON CARVAN
Title or Position: DIRECTOR OF REVENUE
Credential:
Phone: 662-473-5143