Healthcare Provider Details

I. General information

NPI: 1104138940
Provider Name (Legal Business Name): MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 1ST ST
CLEVELAND MS
38732-2310
US

IV. Provider business mailing address

1350 E WOODROW WILSON AVE
JACKSON MS
39216-5112
US

V. Phone/Fax

Practice location:
  • Phone: 662-846-6555
  • Fax: 662-846-6655
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GARY ARMSTRONG
Title or Position: CFO
Credential:
Phone: 601-981-2611