=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154115822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOA VIDA HOSPITAL OF ABERDEEN, MS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2025
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 CENTRAL ST
-----------------------------------------------------
City | WATER VALLEY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38965-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-714-4460
-----------------------------------------------------
Fax | 662-714-4480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10996 FOUR SEASONS PL STE 100C
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-7762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-228-4355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KIRNJOT SINGH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 219-228-4355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------