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General NPI Number Information
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NPI Number | 1013217074
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Entity Type | Organization
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Legal Business Name | SHARKEY ISSAQUENA COMM HOSPITAL - RADIOLOGY
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 47 S FOURTH ST
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City | ROLLING FORK
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State | MS
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Zip | 39159-5146
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Country | US
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Telephone | 662-873-5171
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Fax | 662-873-5194
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Provider Business Mailing Address
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Address Line | 47 S FOURTH ST
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City | ROLLING FORK
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State | MS
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Zip | 39159-5146
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Country | US
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Telephone | 662-873-5171
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Fax | 662-873-5194
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Authorized Official
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Title or Position | DIRECTOR HIS / BUSINESS OFFICE
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Name | KIMBERLY LORETO
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Credential |
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Telephone | 662-873-5171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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