Healthcare Provider Details

I. General information

NPI: 1649386061
Provider Name (Legal Business Name): SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/14/2023
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DELAWARE AVE STE B
MCCOMB MS
39648-3827
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-250-4344
  • Fax: 601-250-4345
Mailing address:
  • Phone: 601-249-2701
  • Fax: 601-249-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLA ROWLEY
Title or Position: CEO
Credential:
Phone: 601-249-1806