1548883481 NPI number — TYLER HOLMES MEMORIAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548883481 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:
1548883481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 TYLER HOLMES DR
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:
38967-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-283-4114
Provider Business Mailing Address Fax Number:
662-283-6125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 GEORGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CARROLLTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-989-1574
Provider Business Practice Location Address Fax Number:
662-989-1569
Provider Enumeration Date:
05/27/2020

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: 001608351 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001709891 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700426707 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1497164446 . 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 , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 000015590 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200007660 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548883481 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1568502714 . This is a "NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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