NPIMap

Organization Active NPI

George County Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Lucedale, MS
National Provider Identifier
1932166444
Registry record updated Nov 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
11-166 Issued in MS
Legal business name
GEORGE COUNTY HOSPITAL
Practice address
859 Winter St
Lucedale, MS 39452-6603
Phone
(601) 947-3161
Fax
(601) 947-9206
NPI assigned
Apr 27, 2006
Last updated
Nov 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2010

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

Authorized official

Name
Mr. Paul A Gardner
Title
Ceo
Phone
(601) 947-9148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 11-166 MS Primary

Addresses

Primary practice location

859 Winter St
Lucedale, MS 39452-6603

Mailing address

PO Box 607
Lucedale, MS 39452-0607
Phone (601) 947-3161

Other identifiers 1

IdentifierTypeStateIssuer
0020290MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080422000873 MS Part A Provider - Hospital 5294717013 Practice locations: Lucedale, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932166444. Details of each certification follow.

Hospital certification: CCN 25U036

Legal name
GEORGE COUNTY HOSPITAL
Doing business as
GEORGE COUNTY HOSPITAL -- SWING BED UNIT
Organization structure
OtherProprietary
Enrollment address
859 Winter Street
George County Hospital-Swing Bed
Lucedale, MS 39452-6603
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
George Countymobile Inf10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Greg Havard Individual Corporate Director Jan 12, 2015
W-2 Managing EmployeeCeo Jan 12, 2015

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Wiggins Primary CareWiggins, MS, CCN 258527 Rural health clinic 5% Or Greater Direct Ownership Interest Jun 1, 2005
Community Medical CenterLucedale, MS, CCN 253988 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 1993
Jul 1, 1993
Obstetrics & Gynecology AssociatesLucedale, MS, CCN 253481 Rural health clinic 5% Or Greater Direct Ownership Interest Jun 23, 1997
Greene County Family Medical ClinicLeakesville, MS, CCN 258544 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Aug 1, 2007
Aug 1, 2024

Owned or controlled facilities with NPI records 4

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289779200000",
    "number": "1932166444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394520607",
            "telephone_number": "601-947-3161",
            "fax_number": "601-947-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 WINTER ST",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394526603",
            "telephone_number": "601-947-3161",
            "fax_number": "601-947-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2010-11-15",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-947-9148",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MS",
            "license": "11-166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0020290",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lucedale, MS

Sources for this page

Verify at the official NPI Registry.