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Organization

JEFFERSON COUNTY HOSPITAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. WANDA FLEMING (ADMINISTRATOR)
(601) 786-3401
Entity
Organization

Contact information

Practice address
870 MAIN ST, FAYETTE, MS 39069-5695
(601) 786-3401
(601) 786-3400
Mailing address
PO BOX 577, FAYETTE, MS 39069-0577
(601) 786-3401
(601) 786-3400

Taxonomy

Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
21-238
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
25S060
MEDICARE PTAN
MS
Enumeration date
11/18/2015
Last updated
11/18/2015
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