Healthcare Provider Details

I. General information

NPI: 1285070672
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 C. T. SWITZER DR. SUITE 404
BILOXI MS
39531-4535
US

IV. Provider business mailing address

PO BOX 555
BILOXI MS
39533-0555
US

V. Phone/Fax

Practice location:
  • Phone: 228-865-3030
  • Fax:
Mailing address:
  • Phone: 228-575-1700
  • Fax: 228-575-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF T STEINER
Title or Position: VP OF FINANCE
Credential:
Phone: 228-865-3030