Yalobusha General Hospital
Organization Active NPI Nurse Practitioner · Water Valley, MS
NPI 1386024438 · NPPES record last updated Jun 4, 2015
Key facts
- NPI
- 1386024438
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- YALOBUSHA GENERAL HOSPITAL
- Practice address
- 606 S Main St
Water Valley, MS 38965-3468 - Phone
- (662) 473-5242
- Fax
- (662) 473-4191
- NPI assigned
- Jun 4, 2015
- Organization subpart
- No
Authorized official
- Name
- Stephanie Surrette Burns
- Title
- Clinic Administrator
- Phone
- (662) 473-5242
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 15
Practitioners 13
-
Bryan Barksdale, MD
-
William Francis Campbell, M.D.
-
Tippini K Conley, CFNP
-
Whitney Roberson Crow, FNP-C
-
Anthony Wade Jackson Sr., M.D.
-
Michael R. McMullan, M.D.
-
Jessica Richardson, FNP
-
Katherine Chaffin Smith, CFNP
-
Adel Abdalla, M.D.
-
Philip B. McDonald, M.D.
-
Deana Terry, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050331000530 | MS | Part B Supplier - Clinic/Group Practice | 4486601648 |
Receives reassigned benefits from 37 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Water Valley, MS |
National Provider Directory
- Tax ID family
- Yalobusha General Hospi
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
606 S Main St
Water Valley, MS 38965-3468
Mailing address
606 S Main St
Water Valley, MS 38965-3468
Phone (662) 473-5242
Other names
- Water Valley Walk In Clinic
Other providers in Water Valley, MS
- Latoya Lynn Woodard
- Yalobusha County Nursing Home Dba Yalobusha General Hospital
- Yalobusha General Hospital
- Yalobusha General Hospital
- Yalobusha General Hospital
- Yalobusha General Hospital
- Yalobusha General Hospital
- Yalobusha General Hospital
- Yalobusha General Hospital
- Yalobusha General Hospital
All providers in Water Valley, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2015. 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.