Organization
SHARKEY ISSAQUENA COMM HOSP-ER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY LORETO (DIRECTOR HIS / BUSINESS OFFICE)
(662) 873-5171
Entity
Organization
Contact information
Practice address
47 S FOURTH ST, ROLLING FORK, MS 39159-5146
(662) 873-5171
(662) 873-5194
Mailing address
47 S FOURTH ST, ROLLING FORK, MS 39159-5146
(662) 873-5171
(662) 873-5194
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013019
—
MS
Enumeration date
10/25/2010
Last updated
10/25/2010
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