=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003834979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESHOBA COUNTY GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 08/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 HOSPITAL RD W
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-663-1210
-----------------------------------------------------
Fax | 601-663-1211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 HOSPITAL RD W
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-663-1210
-----------------------------------------------------
Fax | 601-663-1211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. GARY LEE MCCALL JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-663-1360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 258559
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------