Healthcare Provider Details

I. General information

NPI: 1073948790
Provider Name (Legal Business Name): YALOBUSHA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 FROSTLAND DR
WATER VALLEY MS
38965-2822
US

IV. Provider business mailing address

218 FROSTLAND DR
WATER VALLEY MS
38965-2822
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-1411
  • Fax: 662-473-4991
Mailing address:
  • Phone: 662-473-1411
  • Fax: 662-473-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

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