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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25D0864691	OTHER	MS	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598769044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVINGTON COUNTY HOSPITAL

Provider Business Mailing Address
First Line	:	P.O. BOX 2499
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-2499
Country	:	US
Telephone Number	:	601-765-3180
Fax Number	:	601-765-2808

Provider Business Practice Location Address
First Line	:	301 HOSPITAL BLVD
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-4225
Country	:	US
Telephone Number	:	601-765-3180
Fax Number	:	601-765-2808

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/16/2023

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Directions to “COVINGTON COUNTY HOSPITAL ” Practice Location

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