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Organization
PROMISE HOSPITAL OF VICKSBURG INC
Active
Organization
PROMISE HOSPITAL OF VICKSBURG INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES HOPWOOD (CFO)
(561) 869-3100
Entity
Organization
Contact information
Practice address
2100 HIGHWAY 61 N FL 6, VICKSBURG, MS 39183
(601) 883-3265
(601) 883-3279
Mailing address
999 YAMATO ROAD, 3RD FLOOR, BOCA RATON, FL 33431
(561) 869-3100
(561) 826-0171
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
22-334
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000020813
BLUE CROSS REGULAR PROV #
MS
01
—
000021834
BLUE CROSS STATE EMPLOYEE
MS
Enumeration date
03/22/2006
Last updated
05/16/2018
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