1114923059 NPI number — SOUTH CENTRAL REGIONAL MEDICAL CENTER

Table of content: (NPI 1114923059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114923059 NPI number — SOUTH CENTRAL REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114923059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 607
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39441-0607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-399-6103
Provider Business Mailing Address Fax Number:
601-399-6254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 E IVY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLISVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39437-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-477-9381
Provider Business Practice Location Address Fax Number:
601-477-9870
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CANIZARO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
601-426-4504

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  11153 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com