Healthcare Provider Details

I. General information

NPI: 1366066060
Provider Name (Legal Business Name): SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MARION AVE
MCCOMB MS
39648-2706
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-250-4381
  • Fax: 601-250-4367
Mailing address:
  • Phone: 601-250-4366
  • Fax: 601-250-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MARIA WEEMS
Title or Position: ENROLLMENTS
Credential:
Phone: 601-250-4366