MEDICARE: NESHOBA COUNTY GENERAL 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	208000000X	Pediatrics Physician		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942399118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NESHOBA COUNTY GENERAL HOSPITAL

Provider Business Mailing Address
First Line	:	1122 E MAIN ST STE 6
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2348
Country	:	US
Telephone Number	:	601-656-9900
Fax Number	:	601-656-9933

Provider Business Practice Location Address
First Line	:	1122 E MAIN ST STE 6
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2348
Country	:	US
Telephone Number	:	601-656-9900
Fax Number	:	601-656-9933

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. RITA J THOMAS
Credential	:
Telephone Number	:	601-656-9900

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/21/2022

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Practice Location Address:

1122 E MAIN ST , NESHOBA PEDIATRICS SUITE 6
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1275621211 — NESHOBA COUNTY GENERAL HOSPITAL
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Practice Fax: 601-656-7555

1740479377 — DENITA KAYE THOMAS FNP
Practice Location Address:

1122 E MAIN ST STE 6
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39350-2348

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1164727269 — TONIA HOLLEY NP
Practice Location Address:

1122 E MAIN ST , SUITE 4
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1922068634 — STEPHEN P HAUPTMAN DO
Practice Location Address:

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Directions to “NESHOBA COUNTY GENERAL HOSPITAL ” Practice Location

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