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General NPI Number Information
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NPI Number | 1073118501
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Entity Type | Organization
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Legal Business Name | SHARKEY ISSAQUENA COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 283 W RACE ST
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City | ROLLING FORK
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State | MS
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Zip | 39159-2621
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Country | US
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Telephone | 662-873-4395
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | ROLLING FORK
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State | MS
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Zip | 39159-0339
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Country | US
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Telephone | 662-873-4395
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STEVEN GERALD KEEVER
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Credential |
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Telephone | 662-873-4395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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