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Walthall General Hospital

Organization Active NPI Critical Access Hospital · Tylertown, MS

NPI 1255649604 · NPPES record last updated Aug 23, 2022

Key facts

NPI
1255649604
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
11-257 (MS)
Legal business name
WALTHALL GENERAL HOSPITAL
Practice address
200 Hospital Dr
Tylertown, MS 39667
Phone
(601) 876-2122
Fax
(601) 222-0432
NPI assigned
Sep 20, 2010
Organization subpart
No

Authorized official

Name
Ben Hester
Title
C.F.O.
Phone
(601) 288-4225

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 2

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

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 66

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

View all 66

Medicare Care Compare: Hospital

Listed as
Walthall County General Hospital Cah CCN 251324
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in MS

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
Government · Non-profit
Incorporated
in MS
Enrollment address
100 Hospital Dr
Tylertown, MS 39667-2022
Other Hospital Practice Location

Hospital certification: CCN 25Z324

Legal name
WALTHALL GENERAL HOSPITAL
Organization structure
Government · Non-profit
Enrollment address
100 Hospital Drive
Tylertown, MS 39667-2022
Hospital Swing-Bed Unit

Rural health clinic certification: CCN 258568

Legal name
WALTHALL GENERAL HOSPITAL
Doing business as
WALTHALL RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 28, 2012
Last certification
Sep 25, 2019
Ownership / control type
2B
Organization structure
Other · Non-profit
Incorporated
Sep 12, 2022 in MS
Enrollment address
200 Hospital Drive
Tylertown, MS 39667-2020
Related CCNs
250078

All disclosed owners & managing parties 8

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 Director
President		 Oct 1, 2010
Operational/Managerial Control
Ceo		 Jan 1, 2019
Corporate Officer Sep 1, 2012
Ben R Hester
Individual 		W-2 Managing Employee
Cfo		 Aug 1, 2015
Operational/Managerial Control
Cfo		 Aug 1, 2015
Corporate Director
Cfo		 Aug 1, 2015
Forrest County Board of Superviors
Organization · Tylertown, MS
Non-profit 		Operational/Managerial Control Oct 1, 2010
5% Or Greater Direct Ownership Interest Sep 1, 2012 100%
James Lynn Cartlidge
Individual 		Corporate Director Sep 1, 2012
John M Keene
Individual 		Corporate Director Sep 1, 2012
Reginald Woullard
Individual 		Corporate Officer Sep 1, 2012
Corporate Director Sep 1, 2012
Marcus L Hogan
Individual 		Corporate Director Sep 1, 2012
Richard W Preusch
Individual 		Corporate Officer Sep 1, 2012
Corporate Director Sep 1, 2012

Medicare enrollment records

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
This NPI is an additional NPI on the enrollment
Practice locations: Tylertown, MS
O20110301001117 MS Part a Provider - Critical Access Hospital 3678766094 Practice locations: Tylertown, MS
O20120924000526 MS Part a Provider - Rural Health Clinic 3678766094 Practice locations: Tylertown, MS

National Provider Directory

Tax ID family
Walthall General Hospital (3 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Critical Access Hospital 282NC0060X 11-257 MS Yes

Addresses

Primary practice location

200 Hospital Dr
Tylertown, MS 39667

Mailing address

PO Box 15722
Hattiesburg, MS 39404-5722
Phone (601) 288-4338

Other practice location 1

100 Hospital Dr
Tylertown, MS 39667-2099
Phone (601) 876-0455

Other names

  • Walthall Rural Health Clinic Doing business as

Other providers in Tylertown, MS

All providers in Tylertown, MS · Critical Access Hospital in Mississippi

Sources for this page

Verify at the official NPI Registry.