1710708904 NPI number — SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER

Table of content: (NPI 1710708904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710708904 NPI number — SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST MISSISSIPPI 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:
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:
1710708904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCCOMB
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39649-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-250-4366
Provider Business Mailing Address Fax Number:
601-250-4367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
827 F E SELLERS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39654-9378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-587-7405
Provider Business Practice Location Address Fax Number:
601-587-7407
Provider Enumeration Date:
10/21/2024

Additional Information

Authorized Official

Authorized Official Last Name:
ROWLEY
Authorized Official First Name:
CHARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-249-1806

Provider Taxonomy Codes

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

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





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