=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770660920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASPER GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 06/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 S SIXTH ST
-----------------------------------------------------
City | BAY SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39422-9055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-764-4494
-----------------------------------------------------
Fax | 601-764-4649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 S SIXTH ST
-----------------------------------------------------
City | BAY SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39422-9055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-764-4494
-----------------------------------------------------
Fax | 601-764-4649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. MARSHALL KENNETH POSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-764-2101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 00115455
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------