Healthcare Provider Details

I. General information

NPI: 1285649855
Provider Name (Legal Business Name): TYLER HOLMES MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WOODLAND DRIVE
WINONA MS
38967
US

IV. Provider business mailing address

409 TYLER HOLMES DRIVE
WINONA MS
38967
US

V. Phone/Fax

Practice location:
  • Phone: 662-283-3060
  • Fax: 662-283-3553
Mailing address:
  • Phone: 662-283-4114
  • Fax: 662-283-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEMORIE LYONS
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 662-283-6119