=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023620135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESHOBA COUNTY GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2020
-----------------------------------------------------
Last Update Date | 10/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 STRIBLING ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-3344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-656-2672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 HOLLAND AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-663-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. SCOTT HESTER MCNAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-663-1233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------