MEDICARE: MEMORIAL HOSPITAL AT GULFPORT

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	207R00000X	Internal Medicine Physician

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	:	1801128640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HOSPITAL AT GULFPORT

Provider Business Mailing Address
First Line	:	PO BOX 555
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39533-0555
Country	:	US
Telephone Number	:	228-864-0854
Fax Number	:	228-865-1457

Provider Business Practice Location Address
First Line	:	5120 BEATLINE RD
Second Line	:	SUITE A
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3815
Country	:	US
Telephone Number	:	228-868-4287
Fax Number	:	228-868-4293

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MR. JEFF T STEINER
Credential	:
Telephone Number	:	228-865-3106

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	01/03/2011

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Directions to “MEMORIAL HOSPITAL AT GULFPORT ” Practice Location

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