Healthcare Provider Details

I. General information

NPI: 1073758975
Provider Name (Legal Business Name): STONE COUNTY HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 CENTRAL AVE E P O DRAWER 97
WIGGINS MS
39577-9602
US

IV. Provider business mailing address

1434 CENTRAL AVE E
WIGGINS MS
39577-9602
US

V. Phone/Fax

Practice location:
  • Phone: 601-928-6600
  • Fax: 601-928-6658
Mailing address:
  • Phone: 601-928-6600
  • Fax: 601-928-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number12-280
License Number StateMS

VIII. Authorized Official

Name: DARLENE C ODOM
Title or Position: MANAGED CARE
Credential:
Phone: 601-928-5999