Healthcare Provider Details

I. General information

NPI: 1437199213
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 COUNTY HOME RD
ELLISVILLE MS
39437-8455
US

IV. Provider business mailing address

683 COUNTY HOME RD
ELLISVILLE MS
39437-8455
US

V. Phone/Fax

Practice location:
  • Phone: 601-477-3334
  • Fax: 601-477-2323
Mailing address:
  • Phone: 601-477-3334
  • Fax: 601-477-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number160
License Number StateMS

VIII. Authorized Official

Name: STEPHEN H EAST
Title or Position: CFO
Credential:
Phone: 601-399-6144