MEDICARE: YALOBUSHA 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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1942547161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YALOBUSHA GENERAL HOSPITAL

Provider Business Mailing Address
First Line	:	14101 HICKORY STREET
Second Line	:
City	:	OAKLAND
State	:	MS
Zip	:	38948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14101 HICKORY ST.
Second Line	:
City	:	OAKLAND
State	:	MS
Zip	:	38948
Country	:	US
Telephone Number	:	662-473-1411
Fax Number	:

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	JOE MEURRIER
Credential	:
Telephone Number	:	662-473-1411

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2013

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