MEDICARE: SCOTT REGIONAL MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363LF0000X	Family Nurse Practitioner
3	261QR1300X	Rural Health Clinic/Center

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	:	1679831531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT REGIONAL MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	DEPT 3029 PO BOX 1000
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-3029
Country	:	US
Telephone Number	:	601-213-3010
Fax Number	:	601-213-3011

Provider Business Practice Location Address
First Line	:	1080 HIGHWAY 35 S
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-9423
Country	:	US
Telephone Number	:	601-469-3555
Fax Number	:	601-469-3584

Authorized Official
Title or Position	:	REGIONAL CEO
Name	:	DON LARKIN KENNEDY
Credential	:
Telephone Number	:	601-703-9614

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/21/2023

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