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General NPI Number Information
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NPI Number | 1932168416
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Entity Type | Organization
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Legal Business Name | PROMISE HOSPITAL OF VICKSBURG INC
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 2100 HIGHWAY 61 N FL 6
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City | VICKSBURG
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State | MS
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Zip | 39183
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Country | US
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Telephone | 601-883-3265
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Fax | 601-883-3279
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Provider Business Mailing Address
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Address Line | 999 YAMATO ROAD 3RD FLOOR
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City | BOCA RATON
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State | FL
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Zip | 33431
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Country | US
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Telephone | 561-869-3100
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Fax | 561-826-0171
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Authorized Official
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Title or Position | CFO
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Name | MR. JAMES HOPWOOD
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Credential |
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Telephone | 561-869-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 22-334
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License Number State | MS
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