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NPI Code Detail

MEDICARE: GRAND BAY MEDICAL CENTER, INC.

MEDICARE: GRAND BAY MEDICAL CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center
2261QR1300XRural Health Clinic/Center

General Provider Information

NPI Number : 1558570978
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAND BAY MEDICAL CENTER, INC.
Provider Business Mailing Address
First Line : 2012 HIGHWAY 90
Second Line : SUITE 34
City : GAUTIER
State : MS
Zip : 39553-5306
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10075 GRAND BAY WILMER RD S
Second Line :
City : GRAND BAY
State : AL
Zip : 36541-5003
Country : US
Telephone Number : 251-865-9111
Fax Number :
Authorized Official
Title or Position : ASSOC. ADMIN. OF BUS. DEVELOPMENT
Name : MR. GREG SHOEMAKER
Credential :
Telephone Number : 228-497-7909
Provider Enumeration Date : 05/22/2007
Last Update Date : 03/30/2009

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Directions to “GRAND BAY MEDICAL CENTER, INC. ” Practice Location

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