Healthcare Provider Details

I. General information

NPI: 1043132541
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AT GULFPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 BIENVILLE BLVD STE A
OCEAN SPRINGS MS
39564-5702
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-0585
  • Fax: 228-818-0588
Mailing address:
  • Phone: 228-867-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE LYONS
Title or Position: MANAGER, PAYOR ENROLLMENT
Credential:
Phone: 228-822-6086