Healthcare Provider Details

I. General information

NPI: 1023358132
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 JEFFERSON ST
LAUREL MS
39440-4243
US

IV. Provider business mailing address

1410 JEFFERSON ST
LAUREL MS
39440-4243
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-5931
  • Fax: 601-425-7524
Mailing address:
  • Phone: 601-649-5931
  • Fax: 601-425-7524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES T CANIZARO
Title or Position: VP OF FINANCE/CFO
Credential: CPA
Phone: 601-399-6139