Organization
PEARL RIVER COUNTY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BOLEWARE (ADMINISTRATOR)
(601) 795-4543
Entity
Organization
Contact information
Practice address
305 WEST MOODY STREET, POPLARVILLE, MS 39470
(601) 795-4543
(601) 795-4238
Mailing address
PO BOX 392, POPLARVILLE, MS 39470
(601) 795-4543
(601) 795-4238
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
21087
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000020560
BLUE CROSS
MS
05
—
00220297
—
MS
Enumeration date
02/05/2007
Last updated
09/02/2011
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