Sharkey Issaquena Community Hospital
Organization Active NPI Multi-Specialty Clinic/Center · Rolling Fork, MS
NPI 1073118501 · NPPES record last updated May 11, 2023
Key facts
- NPI
- 1073118501
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- SHARKEY ISSAQUENA COMMUNITY HOSPITAL
- Practice address
- 283 W Race St
Rolling Fork, MS 39159-2621 - Phone
- (662) 873-4395
- NPI assigned
- Dec 2, 2020
- Organization subpart
- No
Authorized official
- Name
- Steven Gerald Keever
- Title
- Ceo
- Phone
- (662) 873-4395
Other NPIs on the same Medicare enrollment 2
Practitioners 7
-
Susan Caselli, CFNP
-
Brandon Goldsmith, FNP
-
Luther Brandon Oakes, M.D.
-
Benjamin Ozbun, MD
-
Allen Brantley Pearson, FNP-C
-
Indira K Veerisetty, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040126000869 | MS | Part B Supplier - Clinic/Group Practice | 1759283039 |
Receives reassigned benefits from 19 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rolling Fork, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
283 W Race St
Rolling Fork, MS 39159-2621
Mailing address
PO Box 339
Rolling Fork, MS 39159-0339
Phone (662) 873-4395
Other names
- Sharkey Issaquena Medical Clinic
Other providers in Rolling Fork, MS
- Sharkey Issaquena Comm Hosp - Ekg
- Sharkey Issaquena Comm Hosp-Ambulance
- Sharkey Issaquena Comm Hosp-ER
- Sharkey Issaquena Comm Hospital - Radiology
- Sharkey Issaquena Community Hospital
- Sharkey Issaquena Community Hospital
- Sharkey Issaquena Community Hospital
- Sharkey Issaquena Community Hospital
- Sharkey-Issaquena Community Hospital
- Sharkey-Issaquena Community Hospital
All providers in Rolling Fork, MS · Multi-Specialty Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.