Provider Demographics
NPI:1679733497
Name:TALLAHATCHIE GENERAL HOSPITAL
Entity type:Organization
Organization Name:TALLAHATCHIE GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-625-7111
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-0240
Mailing Address - Country:US
Mailing Address - Phone:662-647-5535
Mailing Address - Fax:662-647-8432
Practice Address - Street 1:201 S MARKET ST
Practice Address - Street 2:POB 230
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2236
Practice Address - Country:US
Practice Address - Phone:662-647-5535
Practice Address - Fax:662-647-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X
MS11-211282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09012481Medicaid
MS000020161OtherBLUE CROSS AND BLUE SHIELD OF MS
MS00020161Medicaid
MS000020161OtherBLUE CROSS AND BLUE SHIELD OF MS