# PEARL RIVER COUNTY HOSPITAL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992915607
- **Authorized official:** MR. MICHAEL BOLEWARE (ADMINISTRATOR)
- **Authorized official phone:** (601) 795-4543

## Contact information

- **Practice address:** 305 WEST MOODY STREET, POPLARVILLE, MS 39470
- **Practice address phone:** (601) 795-4543
- **Practice address fax:** (601) 795-4238
- **Mailing address:** PO BOX 392, POPLARVILLE, MS 39470
- **Mailing address phone:** (601) 795-4543
- **Mailing address fax:** (601) 795-4238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 275N00000X | Medicare Defined Swing Bed Hospital Unit | 21087 | MS | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 09/02/2011