Healthcare Provider Details

I. General information

NPI: 1720900459
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 LORRAINE RD STE A
GULFPORT MS
39503-6101
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-2121
  • Fax:
Mailing address:
  • Phone: 228-867-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE LYONS
Title or Position: MANAGER, PAYER ENROLLMENT
Credential:
Phone: 228-822-6086