Organization
ANDERSON REGIONAL MEDICAL CENTER
Active
Other names
Baptist Anderson Professional Fees Vascular
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY M DUCKETT (SR VP / CLO)
(901) 227-5233
Entity
Organization
Contact information
Practice address
2124 14TH ST, MERIDIAN, MS 39301-4040
(601) 703-3480
(601) 703-0124
Mailing address
2124 14TH ST, MERIDIAN, MS 39301-4040
(601) 703-3480
(601) 703-0124
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019046
BLUE CROSS OF MS
MS
05
—
09013083
—
MS
05
—
529908690
—
AL
Enumeration date
04/19/2007
Last updated
08/16/2024
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