Healthcare Provider Details

I. General information

NPI: 1841449501
Provider Name (Legal Business Name): TYLER HOLMES MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 11/11/2008
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 Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

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