MEDICARE: SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1154008811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 490
Second Line	:
City	:	MCCOMB
State	:	MS
Zip	:	39649-0490
Country	:	US
Telephone Number	:	601-250-4366
Fax Number	:	601-250-4367

Provider Business Practice Location Address
First Line	:	802 W RAILROAD AVE
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-9489
Country	:	US
Telephone Number	:	601-250-4420
Fax Number	:	601-250-4421

Authorized Official
Title or Position	:	CEO
Name	:	CHARLA ROWLEY
Credential	:
Telephone Number	:	601-249-1806

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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