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Sharkey Issaquena Community Hospital

Organization Active NPI Rural Health Clinic/Center · Rolling Fork, MS

NPI 1902401425 · NPPES record last updated Dec 29, 2025

Key facts

NPI
1902401425
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Practice address
283 W Race St
Rolling Fork, MS 39159-2621
Phone
(662) 873-4395
NPI assigned
Dec 2, 2020
Organization subpart
No

Authorized official

Name
Steven Gerald Keever
Title
Ceo
Phone
(662) 873-4395

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 1

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

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) 6

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

Facilities with the same owner 1

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

Practitioners 10

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

Rural health clinic certification: CCN 258672

Legal name
SHARKEY ISSAQUENA COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 30, 2022
Last certification
Sep 30, 2022
Ownership / control type
Non-profit – church related
Organization structure
Other · Non-profit
Enrollment address
283 W Race St
Rolling Fork, MS 39159-2621
Related CCNs
251338

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Steven G Keever
Individual 		Corporate Director
Ceo		 Feb 6, 2008 100%
W-2 Managing Employee
Ceo		 Feb 6, 2008 100%
Operational/Managerial Control
Ceo		 Feb 6, 2008 100%
Sharkey Issaquena Community Hospital
Organization · Rolling Fork, MS
Non-profit 		5% Or Greater Direct Ownership Interest Jan 1, 1966

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Sharkey Issaquena Nursing Home
Rolling Fork, MS · CCN 255220		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2016
Jan 1, 2016

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20210408002824 MS Part a Provider - Rural Health Clinic 1759283039 Practice locations: Rolling Fork, MS

National Provider Directory

Tax ID family
Sharkey Issaquena Comm Hosp-ER (7 organizations share this tax ID)

Locations

283 W Race St
Rolling Fork, MS 39159
Phone (662) 873-0477

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

283 W Race St
Rolling Fork, MS 39159-2621

Mailing address

PO Box 339
Rolling Fork, MS 39159-0339
Phone (662) 873-4395

Other names

  • Sharkey Issaquena Medical Clinic Doing business as

Other providers in Rolling Fork, MS

All providers in Rolling Fork, MS · Rural Health Clinic/Center in Mississippi

Sources for this page

Verify at the official NPI Registry.