Healthcare Provider Details

I. General information

NPI: 1134762610
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 JEFFERSON ST
LAUREL MS
39440-4355
US

IV. Provider business mailing address

PO BOX 607
LAUREL MS
39441-0607
US

V. Phone/Fax

Practice location:
  • Phone: 601-518-7054
  • Fax: 601-399-6254
Mailing address:
  • Phone: 601-399-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY HASBARGEN
Title or Position: DIRECTOR
Credential:
Phone: 601-399-6105