MEDICARE: TALLAHATCHIE 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	275N00000X	Medicare Defined Swing Bed Hospital Unit	11-211	MS
2	282NC0060X	Critical Access Hospital	11-211	MS

General Provider Information

NPI Number	:	1992706303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALLAHATCHIE GENERAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 230
Second Line	:	141 DR. TT LEWIS CIRCLE
City	:	CHARLESTON
State	:	MS
Zip	:	38921-0240
Country	:	US
Telephone Number	:	662-647-5535
Fax Number	:	662-647-3677

Provider Business Practice Location Address
First Line	:	141 DR. T T LEWIS CIRCLE
Second Line	:
City	:	CHARLESTON
State	:	MS
Zip	:	38921-2236
Country	:	US
Telephone Number	:	662-647-5535
Fax Number	:	662-647-3677

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	BARBARA CROCKER
Credential	:
Telephone Number	:	662-625-7176

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/16/2024

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Directions to “TALLAHATCHIE GENERAL HOSPITAL ” Practice Location

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