Healthcare Provider Details

I. General information

NPI: 1932211851
Provider Name (Legal Business Name): SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
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 788
MONTICELLO MS
39654-0788
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number11-222
License Number StateMS

VIII. Authorized Official

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