Healthcare Provider Details

I. General information

NPI: 1548409196
Provider Name (Legal Business Name): TYLER HOLMES MEMORIAL HOSPITAL ERP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 TYLER HOLMES DR
WINONA MS
38967-1521
US

IV. Provider business mailing address

409 TYLER HOLMES DR
WINONA MS
38967-1521
US

V. Phone/Fax

Practice location:
  • Phone: 662-283-4114
  • Fax: 662-283-4640
Mailing address:
  • Phone: 662-283-4114
  • Fax: 662-283-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. R M TYLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-283-6127