25D0651947 CLIA NUMBER - JEFFERSON DAVIS COMMUNITY HOSPITAL

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Laboratory Demographics

CLIA Number: 25D0651947

Facility Name: JEFFERSON DAVIS COMMUNITY HOSPITAL

Facility Address:
1102 ROSE STREET
PRENTISS, MS
ZIP 39474
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Facility Phone Number: 601 792-1168

Facility Type: Hospital

Certificate Type: Certificate of Compliance

NPI Number: 1649558388

Taxonomy: 275N00000X - Medicare Defined Swing Bed Unit
A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit.

CLIA Record

Field Name	Field Value
CLIA Number	25D0651947
LAB Type	Hospital
Facility Name	JEFFERSON DAVIS COMMUNITY HOSPITAL
Street	1102 ROSE STREET
City	PRENTISS
State	MS
ZIP	39474
Phone	601 792-1168
CertificateType	2
CertificateEffectiveDate	1/12/2023
CertificateExpirationDate	1/11/2025
FacilityType	Compliance

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This page was last updated on: 4/23/2024