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	:	1356923007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVINGTON COUNTY HOSPITAL

Provider Business Mailing Address
First Line	:	701 S HOLLY AVE
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-3894
Country	:	US
Telephone Number	:	601-837-7380
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 HIGHWAY 35
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-6211
Country	:	US
Telephone Number	:	601-837-7380
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	ANISSA L EVANS
Credential	:
Telephone Number	:	601-698-0328

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	04/22/2021

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Directions to “COVINGTON COUNTY HOSPITAL ” Practice Location

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