MEDICARE: MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1104138940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	1350 E WOODROW WILSON AVE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-5112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 1ST ST
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2310
Country	:	US
Telephone Number	:	662-846-6555
Fax Number	:	662-846-6655

Authorized Official
Title or Position	:	CFO
Name	:	GARY ARMSTRONG
Credential	:
Telephone Number	:	601-981-2611

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	10/15/2010

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