Healthcare Provider Details

I. General information

NPI: 1215282991
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WAYNE DRIVE
LAUREL MS
39440
US

IV. Provider business mailing address

525 WAYNE DR.
LAUREL MS
39440
US

V. Phone/Fax

Practice location:
  • Phone: 601-399-7020
  • Fax: 601-399-6281
Mailing address:
  • Phone: 601-399-7020
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES T CANIZARO
Title or Position: VICE PRESIDENT-CFO
Credential:
Phone: 601-399-6204