Healthcare Provider Details

I. General information

NPI: 1932410594
Provider Name (Legal Business Name): MMEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LEISURE TIME DR SUITE A
DIAMONDHEAD MS
39525-3241
US

IV. Provider business mailing address

PO BOX 555
BILOXI MS
39533-0555
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-4300
  • Fax: 228-255-3626
Mailing address:
  • Phone: 228-864-8454
  • Fax: 228-865-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF T STEINER
Title or Position: VP FINANCE
Credential:
Phone: 228-865-3106