Organization
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Active
Parent organization
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Other names
South Central Reg Med Ctr-MNT
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Authorized official
JAMES T CANIZARO (CFO)
(601) 426-4504
Entity
Organization
Contact information
Practice address
1220 JEFFERSON ST, LAUREL, MS 39440-4355
(601) 426-4000
(601) 399-6254
Mailing address
PO BOX 607, LAUREL, MS 39441-0607
(601) 426-4000
(601) 399-6254
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
11-153
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019141
BLUE CROSS OF MS
MS
05
—
08759070
—
MS
01
—
512G700476
MEDICARE PTAN
MS
Enumeration date
01/10/2007
Last updated
11/03/2010
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