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Organization
MEMORIAL HOSPITAL AT GULFPORT
Active
Organization
MEMORIAL HOSPITAL AT GULFPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENT NICAUD (CEO)
(228) 865-3076
Entity
Organization
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 867-3076
(228) 865-3098
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 867-3076
(228) 865-3098
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019027
BLUE CROSS
MS
05
—
00020027
—
MS
05
—
000260081X
—
GA
05
—
0250019
—
TN
01
—
027
BLUE CROSS BLUE SHIELD MS
MS
05
—
1731625
—
LA
05
—
1887007
—
TN
05
—
1943061
—
LA
01
—
374535800
US DEPT OF LABOR NUMBER
MS
05
—
901382200
—
FL
01
—
C00042
CAHABA PROVIDER NUMBER
MS
01
—
CA1177
RAILROAD MEDICARE
MS
05
—
MEM0019N
—
AL
Enumeration date
10/02/2006
Last updated
01/09/2024
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