Organization
TALLAHATCHIE GENERAL HOSPITAL
Active
Other names
CHARLESTON RURAL HEALTH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA DOVER CROCKER (HIM DIRECTOR)
(662) 625-7176
Entity
Organization
Contact information
Practice address
171 DR. T T LEWIS CIRCLE, CHARLESTON, MS 38921-2257
(662) 647-5535
(662) 647-8432
Mailing address
PO BOX 230, CHARLESTON, MS 38921-0240
(662) 647-5535
(662) 647-8432
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014008
—
MS
01
—
=========
BLUE CROSS
MS
Enumeration date
02/21/2007
Last updated
04/09/2025
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