Healthcare Provider Details

I. General information

NPI: 1285772228
Provider Name (Legal Business Name): MISSISSIPPI METHODIST HOSPITAL REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 14TH ST
MERIDIAN MS
39301-4242
US

IV. Provider business mailing address

1350 E WOODROW WILSON AVE
JACKSON MS
39216-5112
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-5280
  • Fax:
Mailing address:
  • Phone: 601-981-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number43-278
License Number StateMS

VIII. Authorized Official

Name: GARY ARMSTRONG
Title or Position: EXEC VICE PRESIDENT
Credential:
Phone: 601-981-2611