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	332B00000X	Durable Medical Equipment & Medical Supplies	43-278	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598803926
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	:	601-981-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 LOUISVILLE AVE
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-6027
Country	:	US
Telephone Number	:	318-410-0846
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	11/11/2010

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