MEDICARE: COVINGTON COUNTY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1013205350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVINGTON COUNTY HOSPITAL

Provider Business Mailing Address
First Line	:	3275 HWY 49
Second Line	:	SUITE E
City	:	COLLINS
State	:	MS
Zip	:	39428
Country	:	US
Telephone Number	:	601-765-6711
Fax Number	:	601-765-2808

Provider Business Practice Location Address
First Line	:	3275 HWY 49
Second Line	:	SUITE E
City	:	COLLINS
State	:	MS
Zip	:	39428
Country	:	US
Telephone Number	:	601-765-6711
Fax Number	:	601-765-2808

Authorized Official
Title or Position	:	CFO
Name	:	KIRSTIE EVANS
Credential	:
Telephone Number	:	601-765-6711

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	07/20/2011

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Directions to “COVINGTON COUNTY HOSPITAL ” Practice Location

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