Healthcare Provider Details

I. General information

NPI: 1356402002
Provider Name (Legal Business Name): YALOBUSHA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SOUTH MAIN STREET
WATER VALLEY MS
38965
US

IV. Provider business mailing address

645 HWY 7 SOUTH
WATER VALLEY MS
38965-0645
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-1311
  • Fax:
Mailing address:
  • Phone: 662-473-1311
  • Fax: 662-473-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: TERRY L VARNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-473-1411