Healthcare Provider Details

I. General information

NPI: 1275848889
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 E ALOHA DR SUITE 1
DIAMONDHEAD MS
39525-3380
US

IV. Provider business mailing address

PO BOX 555
BILOXI MS
39533-0555
US

V. Phone/Fax

Practice location:
  • Phone: 228-863-7393
  • Fax:
Mailing address:
  • Phone: 228-864-0854
  • Fax: 228-865-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF T STEINER
Title or Position: VP FINANCE
Credential:
Phone: 228-818-0563