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General NPI Number Information
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NPI Number | 1174562979
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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 | 06/06/2006
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 203 S 12TH AVE
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City | LAUREL
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State | MS
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Zip | 39440
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Country | US
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Telephone | 601-426-6961
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Fax | 601-426-3449
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Provider Business Mailing Address
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Address Line | PO BOX 1649
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City | LAUREL
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State | MS
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Zip | 39441-1649
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Country | US
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Telephone | 601-426-6961
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Fax | 601-426-3449
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Authorized Official
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Title or Position | ASSOCIATE EXECUTIVE DIRECTOR
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Name | MR. JOHN CHIOCO
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Credential | MSHA
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Telephone | 601-426-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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