=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144665670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESHOBA COUNTY GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2013
-----------------------------------------------------
Last Update Date | 08/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1003 HOLLAND AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-2180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-663-1200
-----------------------------------------------------
Fax | 601-663-1497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1003 HOLLAND AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-2180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-663-1200
-----------------------------------------------------
Fax | 601-663-1497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. SCOTT H MCNAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-663-1233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VF0040X
-----------------------------------------------------
Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------