Organization
KILMICHAEL HOSPITAL
Active
Other names
Kilmichael Hospital Professional Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CALVIN DEXTER JOHNSON II (ADMINISTRATOR)
(662) 262-4311
Entity
Organization
Contact information
Practice address
301 LAMAR AVE., KILMICHAEL, MS 39747-0188
(662) 262-4311
(662) 262-5586
Mailing address
PO BOX 188, KILMICHAEL, MS 39747-0188
(662) 262-4311
(662) 262-5586
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12496
MS
207Q00000X
Family Medicine Physician
16482
MS
207RC0000X
Cardiovascular Disease Physician
000010138
MS
207RC0000X
Cardiovascular Disease Physician
10138
MS
2085R0202X
Diagnostic Radiology Physician
Primary
MS06391
MS
363L00000X
Nurse Practitioner
R605859
MS
363LP2300X
Primary Care Nurse Practitioner
R504696
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03335377
—
MS
01
—
19147
PROFESSIONAL COMPONENT
MS
Enumeration date
05/21/2007
Last updated
05/17/2011
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