| South Central Regional Medical Ctr-eeg | |
|
1220 Jefferson St Laurel MS 39440-4355 | |
| (601) 426-4000 | |
| Not Available |
| Full Name | South Central Regional Medical Ctr-eeg |
|---|---|
| Speciality | Internal Medicine |
| Location | 1220 Jefferson St, Laurel, Mississippi |
| Authorized Official Name and Position | James T Canizaro (CFO) |
| Authorized Official Contact | 6014264504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Central Regional Medical Ctr-eeg Po Box 607 Laurel MS 39441-0607 Ph: (601) 399-6103 | South Central Regional Medical Ctr-eeg 1220 Jefferson St Laurel MS 39440-4355 Ph: (601) 426-4000 |
| NPI Number | 1396920484 |
|---|---|
| Provider Enumeration Date | 01/08/2008 |
| Last Update Date | 11/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396920484 | NPI | - | NPPES |
| 09013316 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 11-153 (Mississippi) | Primary |
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