1285649855 NPI number — TYLER HOLMES MEMORIAL HOSPITAL

Table of content: (NPI 1285649855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285649855 NPI number — TYLER HOLMES MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TYLER HOLMES MEMORIAL HOSPITAL
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:
1285649855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 TYLER HOLMES DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-283-4114
Provider Business Mailing Address Fax Number:
662-283-3553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 WOODLAND DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-283-3060
Provider Business Practice Location Address Fax Number:
662-283-3553
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYONS
Authorized Official First Name:
MEMORIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
662-283-6119

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1144840489 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 05586705 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1316557416 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 2466404 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000113703 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003558755 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1497164446 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1700426707 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 09014346 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881600492 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 200007660 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2087948 . This is a "WELLCARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 2375774 . This is a "WELLCARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 006456342 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043662430 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 001608351 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003029302 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285649855 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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