Healthcare Provider Details

I. General information

NPI: 1639228547
Provider Name (Legal Business Name): SCOTT REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 HIGHWAY 13 S
MORTON MS
39117-3353
US

IV. Provider business mailing address

DEPT 3034 PO BOX 1000
MEMPHIS TN
38148-3034
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-6301
  • Fax: 601-732-6476
Mailing address:
  • Phone: 601-213-3010
  • Fax: 601-213-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DON LARKIN KENNEDY
Title or Position: REGIONAL CEO
Credential:
Phone: 601-703-9614