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General NPI Number Information
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NPI Number | 1801905310
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL AT GULFPORT
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 1500 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-3601
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Country | US
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Telephone | 228-868-1314
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Fax | 228-863-8966
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Provider Business Mailing Address
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Address Line | 1500 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-3601
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Country | US
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Telephone | 228-868-1314
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Fax | 228-863-8966
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Authorized Official
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Title or Position | PHYSICIAN BUSINESS SERVICES DIR.
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Name | PEGGY LORRAINE NOONAN
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Credential | BS, CPC
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Telephone | 228-575-1740
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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 | 193
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License Number State | MS
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