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Yalobusha General Hospital

Organization Active NPI General Acute Care Hospital · Water Valley, MS

NPI 1649397308 · NPPES record last updated Jul 1, 2010

Key facts

NPI
1649397308
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
License
11-223 (MS)
Legal business name
YALOBUSHA GENERAL HOSPITAL
Practice address
630 South Main Street
Water Valley, MS 38965-3468
Phone
(662) 473-1411
Fax
(662) 473-4922
NPI assigned
Mar 26, 2007
Organization subpart
No

Authorized official

Name
Mr. Terry Varner
Title
Administrator
Phone
(662) 473-1411

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 15

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 4

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

Practitioners 23

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

Affiliated clinicians 54

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

View all 54

Medicare Care Compare: Hospital

Listed as
Yalobusha General Hospital CCN 250061
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
Active (Provider of Services file)
Emergency services
No

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AR

Hospital certification: CCN 250061

Legal name
YALOBUSHA GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 1, 1966
Last certification
Jan 24, 2024
Beds
32
Ownership / control type
Local
Organization structure
Government · Non-profit
Enrollment address
630 South Main St
Water Valley, MS 38965-3468
Other Hospital Practice Location
Hospital subgroups
Acute care

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jessica Embry
Individual 		Corporate Officer Jan 26, 2020
Corporate Director Jan 26, 2020
W-2 Managing Employee Jan 26, 2020
Kimberly Wilburn
Individual 		W-2 Managing Employee
Business Office Manager		 Jan 1, 2015
Yalobusha General Hospital
Organization · Water Valley, MS 		5% Or Greater Direct Ownership Interest Sep 1, 1966

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Yalobusha General Hospital Swing Bed
Water Valley, MS · CCN 25U061		 Hospital 5% Or Greater Direct Ownership Interest Sep 12, 1985
Odom Rural Health Clinic
Water Valley, MS · CCN 258538		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2007
Oakland Medical Clinic
Oakland, MS · CCN 258585		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2013
Arrington Medical Clinic
Coffeeville, MS · CCN 258598		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 10, 2014

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100616000893 AR Part a Provider - Hospital 4486601648 Practice locations: Ridgeland, MS; Water Valley, MS; Oxford, MS; Meridian, MS; Okolona, MS; Duncan, MS; Clinton, MS

National Provider Directory

Tax ID family
Yalobusha General Hospi (16 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 11-223 MS Yes

Addresses

Primary practice location

630 South Main Street
Water Valley, MS 38965-3468

Mailing address

630 South Main Street
Water Valley, MS 38965-3468
Phone (662) 473-1411

Other identifiers

IdentifierTypeStateIssuer
00020175MedicaidMS
000020175OtherMSBLUE CROSS

Other providers in Water Valley, MS

All providers in Water Valley, MS · General Acute Care Hospital in Mississippi

Sources for this page

Verify at the official NPI Registry.