NPIMap

Organization Active NPI

Walthall General Hospital

Doing business as Walthall Rural Health Clinic

  • Critical Access Hospital
  • Tylertown, MS
National Provider Identifier
1255649604
Registry record updated Aug 23, 2022
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
Doing business as
Walthall Rural Health Clinic
Practice address
200 Hospital Dr
Tylertown, MS 39667
Phone
(601) 876-2122
Fax
(601) 222-0432
NPI assigned
Sep 20, 2010
Last updated
Aug 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Authorized official

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

Specialties & licenses 2

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

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 1

  • Walthall Rural Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

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

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1255649604. 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

Hospital certification: CCN 25Z324

Legal name
WALTHALL GENERAL HOSPITAL
Organization structure
GovernmentNon-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
OtherNon-profit
Incorporated
Sep 12, 2022 in MS
Enrollment address
200 Hospital Drive
Tylertown, MS 39667-2020
Related CCNs
250078

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

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 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 DirectorPresident Oct 1, 2010
Operational/Managerial ControlCeo Jan 1, 2019
Corporate Officer Sep 1, 2012
Ben R Hester Individual W-2 Managing EmployeeCfo Aug 1, 2015
Operational/Managerial ControlCfo Aug 1, 2015
Corporate DirectorCfo 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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

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": "1661212800000",
    "number": "1255649604",
    "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": "394045722",
            "telephone_number": "601-288-4338",
            "fax_number": "601-288-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "39667",
            "telephone_number": "601-876-2122",
            "fax_number": "601-222-0432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Tylertown",
            "state": "MS",
            "postal_code": "396672099",
            "country_code": "US",
            "telephone_number": "601-876-0455",
            "fax_number": "601-876-0482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WALTHALL GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "HESTER",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "C.F.O.",
        "authorized_official_telephone_number": "601-288-4225"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "11-257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walthall Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Walthall Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tylertown, MS

Sources for this page

Verify at the official NPI Registry.