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General NPI Number Information
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NPI Number | 1114923059
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Entity Type | Organization
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Legal Business Name | SOUTH CENTRAL REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 305 E IVY ST
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City | ELLISVILLE
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State | MS
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Zip | 39437-2746
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Country | US
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Telephone | 601-477-9381
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Fax | 601-477-9870
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Provider Business Mailing Address
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Address Line | PO BOX 607
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City | LAUREL
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State | MS
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Zip | 39441-0607
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Country | US
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Telephone | 601-399-6103
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Fax | 601-399-6254
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Authorized Official
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Title or Position | CFO
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Name | JAMES T CANIZARO
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Credential |
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Telephone | 601-426-4504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 11153
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License Number State | MS
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