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Organization
GEORGE COUNTY HOSPITAL- CRNA
Active
Organization
GEORGE COUNTY HOSPITAL- CRNA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL A GARDNER (CEO)
(601) 947-9148
Entity
Organization
Contact information
Practice address
859 WINTER ST, LUCEDALE, MS 39452-6603
(601) 947-3161
(601) 947-9206
Mailing address
859 WINTER ST, LUCEDALE, MS 39452-6603
(601) 947-3161
(601) 947-9206
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
11-166
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019120A
BC BS OF MS
MS
05
—
09013665
—
MS
01
—
C00879
MEDICAE GROUP NUMBER
MS
Enumeration date
06/01/2006
Last updated
11/15/2010
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