Healthcare Provider Details

I. General information

NPI: 1497468151
Provider Name (Legal Business Name): SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 E BROAD ST
MONTICELLO MS
39654-7703
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-587-4051
  • Fax: 601-587-0306
Mailing address:
  • Phone: 601-250-4366
  • Fax: 601-250-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

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