Healthcare Provider Details

I. General information

NPI: 1467183418
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 JEFFERSON ST
LAUREL MS
39440-4243
US

IV. Provider business mailing address

PO BOX 607
LAUREL MS
39441-0607
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-4860
  • Fax:
Mailing address:
  • Phone: 601-426-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY HASBARGEN
Title or Position: DIRECTOR
Credential:
Phone: 601-426-4795