Healthcare Provider Details

I. General information

NPI: 1972503464
Provider Name (Legal Business Name): KING'S DAUGHTERS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

IV. Provider business mailing address

427 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-6011
  • Fax: 601-833-5210
Mailing address:
  • Phone: 601-833-6011
  • Fax: 601-833-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number16235
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: SCOTT CHRISTENSEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-835-9488