Healthcare Provider Details

I. General information

NPI: 1972835619
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 555
BILOXI MS
39533-0555
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-6129
  • Fax: 228-255-6431
Mailing address:
  • Phone: 228-864-0854
  • Fax: 228-865-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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