Healthcare Provider Details

I. General information

NPI: 1841913068
Provider Name (Legal Business Name): SOUTH CENTRAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 JEFFERSON STREET SUITE 3
LAUREL MS
39440
US

IV. Provider business mailing address

1620 W. NORTHWEST HWY SUITE 100
GRAPEVINE TX
76051
US

V. Phone/Fax

Practice location:
  • Phone: 601-335-8940
  • Fax: 601-516-8966
Mailing address:
  • Phone: 817-572-0009
  • Fax: 817-572-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN EAST
Title or Position: CFO
Credential:
Phone: 601-399-6144