Healthcare Provider Details

I. General information

NPI: 1609813757
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S 12TH AVE
LAUREL MS
39440-4324
US

IV. Provider business mailing address

PO BOX 2038
LAUREL MS
39442-2038
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-9904
  • Fax: 601-649-9903
Mailing address:
  • Phone: 601-649-9904
  • Fax: 601-649-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. STEVEN W BURFORD
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential: MSHA
Phone: 601-426-4415