Healthcare Provider Details

I. General information

NPI: 1114223880
Provider Name (Legal Business Name): ANDERSON REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 CONSTITUTION AVE
MERIDIAN MS
39301-4001
US

IV. Provider business mailing address

2124 14TH ST
MERIDIAN MS
39301-4040
US

V. Phone/Fax

Practice location:
  • Phone: 601-693-2511
  • Fax: 601-484-3130
Mailing address:
  • Phone: 601-553-6000
  • Fax: 601-553-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number12249
License Number StateMS

VIII. Authorized Official

Name: GREGORY M DUCKETT
Title or Position: SR VP / CLO
Credential:
Phone: 901-227-5233