NPIMap

Organization Active NPI

Walthall General Hospital

  • Critical Access Hospital
  • Tylertown, MS
National Provider Identifier
1023326485
Registry record updated Sep 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
11-257 Issued in MS
Legal business name
WALTHALL GENERAL HOSPITAL
Practice address
100 Hospital Dr
Tylertown, MS 39667-2022
Phone
(601) 876-2122
Fax
(601) 222-0432
NPI assigned
Sep 20, 2010
Last updated
Sep 13, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
FORREST GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ben Hester
Title
Cfo
Phone
(601) 288-4225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 11-257 MS Primary

Addresses

Primary practice location

100 Hospital Dr
Tylertown, MS 39667-2022

Mailing address

PO Box 15722
Hattiesburg, MS 39404
Phone (601) 288-1889

Other identifiers 1

IdentifierTypeStateIssuer
251324OtherMSMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101018001311 MS Part A Provider - Critical Access Hospital 3678766094 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Tylertown, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023326485. Details of each certification follow.

Hospital certification: CCN 251324

Legal name
WALTHALL GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2005
Last certification
Jul 13, 2023
Beds
35
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Incorporated
in MS
Enrollment address
100 Hospital Dr
Tylertown, MS 39667-2022
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Walthall County General Hospital CahCCN 251324 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Walthall General Hospital3 organizations share this tax ID, including this one
Part of
Forrest Cty Gen Hosp

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Richard Andy Woodard Individual Corporate DirectorPresident Oct 1, 2010
Operational/Managerial ControlCeo Jan 1, 2019
Ben R Hester Individual W-2 Managing EmployeeCfo Aug 1, 2015
Operational/Managerial ControlCfo Aug 1, 2015

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 66

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 66

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505260800000",
    "number": "1023326485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15722",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39404",
            "telephone_number": "601-288-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396672022",
            "telephone_number": "601-876-2122",
            "fax_number": "601-222-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTHALL GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORREST GENERAL HOSPITAL",
        "enumeration_date": "2010-09-20",
        "last_updated": "2017-09-13",
        "status": "A",
        "authorized_official_last_name": "HESTER",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-288-4225",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "11-257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "251324",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tylertown, MS

Sources for this page

Verify at the official NPI Registry.