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Organization
PICAYUNE CLINIC LLC
Active
Organization
PICAYUNE CLINIC LLC
Active
Other names
Crosby Memorial Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE GRIMM (CEO)
(601) 798-4711
Entity
Organization
Contact information
Practice address
801 GOODYEAR BLVD, PICAYUNE, MS 39466-3221
(601) 798-4711
(601) 749-3187
Mailing address
801 GOODYEAR BLVD, PICAYUNE, MS 39466-3221
(601) 798-4711
(601) 749-3187
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
12086
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00220682
—
MS
Enumeration date
08/10/2005
Last updated
08/22/2020
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