Healthcare Provider Details

I. General information

NPI: 1811819311
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 BENIGNO LN
BAY ST LOUIS MS
39520-1602
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-467-2555
  • Fax: 228-467-5480
Mailing address:
  • Phone: 228-867-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE LYONS
Title or Position: MANAGER, PAYER ENROLLMENT
Credential:
Phone: 228-822-6086