Organization
JEFFERSON COUNTY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY KENNEDY (INTERM CEO)
(601) 597-4979
Entity
Organization
Contact information
Practice address
870 SOUTH MAIN STREET, FAYETTE, MS 39069-0577
(601) 786-3401
(601) 786-3400
Mailing address
P.O. BOX 577, 870 MAIN STREET, FAYETTE, MS 39069-0577
(601) 786-3401
(601) 786-3400
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
21238
MS
282N00000X
General Acute Care Hospital
21238
MS
282NR1301X
Rural Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02109
BLUE CROSS BLUE SHIELD
MS
Enumeration date
09/12/2005
Last updated
03/22/2024
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