Healthcare Provider Details

I. General information

NPI: 1629287719
Provider Name (Legal Business Name): SINGING RIVER HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 HIGHWAY 614
MOSS POINT MS
39562
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-588-2938
  • Fax:
Mailing address:
  • Phone: 228-497-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE BOND
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 228-809-2074