Healthcare Provider Details

I. General information

NPI: 1821336603
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 JEFFERSON ST
LAUREL MS
39440-4350
US

IV. Provider business mailing address

PO BOX 607
LAUREL MS
39441-0607
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-7802
  • Fax: 601-428-7841
Mailing address:
  • Phone: 601-649-7802
  • Fax: 601-428-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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