NPIMap

Organization Active NPI

Prentiss Regional Hospital and Ecf, Inc.

Doing business as Jefferson Davis Community Hospital

  • Critical Access Hospital
  • Prentiss, MS
National Provider Identifier
1063620110
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
16-179 Issued in MS
Legal business name
PRENTISS REGIONAL HOSPITAL AND ECF, INC.
Doing business as
Jefferson Davis Community Hospital
Practice address
1102 Rose St
Prentiss, MS 39474
Phone
(601) 792-4276
Fax
(601) 792-2947
NPI assigned
May 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Gary Lee McCall Jr.
Title
Coo
Phone
(601) 792-4276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 16-179 MS Primary

Addresses

Primary practice location

1102 Rose St
Prentiss, MS 39474

Mailing address

PO Box 1288
Prentiss, MS 39474-1288
Phone (601) 792-4276

Other identifiers 1

IdentifierTypeStateIssuer
09014591MedicaidMS

Other names 1

  • Jefferson Davis Community Hospital Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063620110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1288",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "394741288",
            "telephone_number": "601-792-4276",
            "fax_number": "601-792-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 ROSE ST",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "39474",
            "telephone_number": "601-792-4276",
            "fax_number": "601-792-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRENTISS REGIONAL HOSPITAL AND ECF, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCALL",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "601-792-4276",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "16-179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014591",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Davis Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prentiss, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.