NPIMap

Organization Active NPI

Walthall General Hospital

  • Emergency Medicine Physician
  • Tylertown, MS
National Provider Identifier
1245512417
Registry record updated Sep 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11-257 Issued in MS
Legal business name
WALTHALL GENERAL HOSPITAL
Practice address
100 Hospital Drive
Tylertown, MS 39667
Phone
(601) 876-2122
Fax
(601) 876-0432
NPI assigned
Sep 14, 2011
Last updated
Sep 12, 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 12, 2017

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11-257 MS Primary
Internal Medicine Physician 207R00000X 11-257 MS

Addresses

Primary practice location

100 Hospital Drive
Tylertown, MS 39667

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
09013588MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111103000238 MS Part B Supplier - Clinic/Group Practice 3678766094 Receives reassigned benefits from 24 practitioners
Practice locations: Tylertown, MS

Other NPIs with the same Medicare PAC ID 2

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

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.

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505174400000",
    "number": "1245512417",
    "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",
            "fax_number": "601-288-1848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DRIVE",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "39667",
            "telephone_number": "601-876-2122",
            "fax_number": "601-876-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTHALL GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORREST GENERAL HOSPITAL",
        "enumeration_date": "2011-09-14",
        "last_updated": "2017-09-12",
        "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"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "11-257",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "11-257",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013588",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tylertown, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.