Healthcare Provider Details

I. General information

NPI: 1851726202
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST CARDIO-VASCULAR LAB
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

4500 13TH ST CARDIO-VASCULAR LAB
GULFPORT MS
39501-2515
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-2902
  • Fax: 228-867-5245
Mailing address:
  • Phone: 228-575-2902
  • Fax: 228-867-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY T STEINER
Title or Position: VP OF FINANCE
Credential:
Phone: 228-867-4000