Organization
PRENTISS REGIONAL HOSPITAL AND EXTENDED CARE FACILITY, INC.
Active
Other names
Jefferson Davis Community Hospital Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY CURTIS (CEO)
(601) 792-4276
Entity
Organization
Contact information
Practice address
1014 ROSE ST, SUITE A, PRENTISS, MS 39474
(601) 792-4276
(601) 792-2947
Mailing address
P.O. BOX 1288, PRENTISS, MS 39474
(601) 792-4276
(601) 792-2947
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
16-179
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04431581
—
MS
Enumeration date
07/06/2006
Last updated
01/14/2008
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