Healthcare Provider Details

I. General information

NPI: 1932213840
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/23/2008
Certification Date:
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: 601-426-4000
  • Fax: 601-426-4228
Mailing address:
  • Phone: 601-399-6103
  • Fax: 601-399-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number11153
License Number StateMS

VIII. Authorized Official

Name: JAMES T CANIZARO
Title or Position: CFO
Credential:
Phone: 601-426-4504