Organization
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Active
Other names
Laurel Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES T CANIZARO (VICE PRESIDENT/ C.F.O.)
(601) 399-6139
Entity
Organization
Contact information
Practice address
234 S 12TH AVE, LAUREL, MS 39440-4325
(601) 649-3520
(601) 649-7899
Mailing address
PO BOX 1649, LAUREL, MS 39441-1649
(601) 425-7583
(601) 399-6281
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08705378
—
MS
Enumeration date
11/06/2012
Last updated
11/06/2012
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