SOUTH CENTRAL REGIONAL MEDICAL CENTER (NPI# 1619973542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619973542 |
| Entity Type | Organization |
| Organization Name | SOUTH CENTRAL REGIONAL MEDICAL CENTER |
| Practice Address |
1220 Jefferson St Laurel MS 39440-4355 |
| Practice Telephone | 6014264000 |
| Practice Fax Number | 6014264228 |
| Mailing Telephone | 6013996103 |
| Mailing Fax Number | 6013996254 |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2008-04-25 |
| Authorized Official Name | MR. JAMES T CANIZARO (CFO) |
| Authorized Official Telephone | 6014264504 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 11-153 | MS | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00020141 | 05 | |
| MS | 08759070 | 05 | |
| MS | BLUE CROSS | 000020141 | 01 |
| MS | 09013315 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1730121088 | South Central Regional Medical Center | Nursing Facility/Intermediate Care Facility | 1100 West Dr, Laurel, MS 39440-4730 | 2006-06-12 |
| 1437199213 | South Central Regional Medical Center | Skilled Nursing Facility | 683 County Home Rd, Ellisville, MS 39437-8455 | 2006-06-08 |
| 1609813757 | South Central Regional Medical Center | Obstetrics & Gynecology | 203 S 12th Ave, Laurel, MS 39440-4324 | 2006-05-31 |
| 1629058094 | South Central Regional Medical Center | Ambulance | 23 Mason St, Laurel, MS 39440-4437 | 2006-01-20 |
| 1093790404 | South Central Regional Medical Center | Home Health | 2260 Us Highway 15 North, Laurel, MS 39440-1521 | 2005-12-08 |
| 1114923059 | South Central Regional Medical Center | Skilled Nursing Facility | 305 E Ivy St, Ellisville, MS 39437-2746 | 2005-06-24 |
| 1134762610 | South Central Regional Medical Center | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2019-10-28 |
| 1114353539 | South Central Regional Medical Center | Dermatology | 920 Matthew Dr, Suite 8, Waynesboro, MS 39367-2553 | 2013-09-17 |
| 1023358132 | South Central Regional Medical Center | Radiology | 1410 Jefferson St, Laurel, MS 39440-4243 | 2013-02-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTH CENTRAL REGIONAL MEDICAL CENTER, INC | 1220 Jefferson St, Laurel, MS 39440-4355 |
| Street Address |
1220 JEFFERSON ST |
| City | LAUREL |
| State | MS |
| Zip Code | 39440-4355 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730799578 | Holly Marie White | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440-4355 | 2020-08-06 |
| 1407495492 | David Caldwell | Physician Assistant | 1220 Jefferson St, Laurel, MS 39440-4355 | 2019-12-23 |
| 1659918084 | Elizabeth Allen | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440-4355 | 2019-12-04 |
| 1598300626 | Nicole Nielsen | Physical Therapist | 1220 Jefferson St, Laurel, MS 39440-4355 | 2019-11-13 |
| 1437793163 | Marty Jacob Brock | Physical Therapist | 1220 Jefferson St, Laurel, MS 39440-4355 | 2019-11-06 |
| 1881253557 | Sarah M Wooten | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440-4355 | 2019-06-06 |
| 1730742933 | Hanna Rae Mccoy | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440-4355 | 2019-04-15 |
| 1801372685 | Anna Seals | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440-4355 | 2018-07-16 |
| 1982195137 | Erica Windham | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440 | 2018-05-23 |
| 1811414196 | Leslie Ann Fisher | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440-4355 | 2017-08-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306323159 | Tender Loving Care Homecare LLC | Homemaker | 509 Central Ave Ste 224, Laurel, MS 39440 | 2018-07-24 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1568721215 | Terry Ratcliff Perkins | Counselor | 5192 Hwy 11 North, Laurel, MS 39440 | 2012-05-15 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1710135629 | Jeffrey R. Moffett | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2008-09-04 |
| 1003096785 | Family Health Center, Inc | Obstetrics & Gynecology | 103 S. 12th Avenue, Laurel, MS 39440 | 2007-11-09 |
| 1669672143 | Laurel Urology Clinic Pa | Urology | 304 S 10th Ave, Laurel, MS 39440 | 2007-07-23 |
| 1093912370 | Tanweer Hussain Majid | Surgery | 1007 Jefferson Street, Laurel, MS 39440 | 2007-06-29 |
| 1780889923 | Hattiesburg Eye Clinic, Pa | Ophthalmology | 1431 North 10th St, Suite 1, Laurel, MS 39440 | 2007-06-18 |
| Find all providers in zip 39440 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508397738 | Northshore Lij Forest Hills | General Acute Care Hospital | 10102 Stansfield Rd, Laurel, MD 20723-1738 | 2017-03-21 |
| 1336589753 | Vijay Pratap Reddy Kodadhala | General Acute Care Hospital | 9635 Washington Ave, Laurel, MD 20723-1917 | 2013-06-29 |
| 1902089816 | South Central Reg Med Ctr - Vfc | General Acute Care Hospital | 1220 Jefferson St, Laurel, MS 39440-4355 | 2007-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184073181 | 81msgs/sgcq | General Acute Care Hospital | 81msgs/sgcq, 301 Fisher St, Rm 5a127, Keesler Afb, MS 39534 | 2016-06-09 |
| 1013396290 | Martin Hillard Mcmullan | General Acute Care Hospital | 2350 Cooper Rd, Flowood, MS 39232-6136 | 2015-05-21 |
| 1750771580 | Genesis Rehab | General Acute Care Hospital | 438 North St, Union, MS 39365-9506 | 2015-02-02 |
| 1003229469 | Robert J Cole | General Acute Care Hospital | 601 Meadowbrook Cir, Amory, MS 38821-1314 | 2014-06-03 |
| 1295151850 | Mary A. Doss | General Acute Care Hospital | 110 Napoleon Dr, Brandon, MS 39047-9004 | 2014-03-06 |
| 1467755744 | Biloxi Regional Medical Center | General Acute Care Hospital | 1104 Homestead Blvd, Gautier, MS 39553-4612 | 2010-12-08 |
| 1528371119 | University Physicians. Pllc | General Acute Care Hospital | 121 Beaufort Cir, Madison, MS 39110-7962 | 2010-07-23 |
| 1306047436 | Alliance Healthcare System | General Acute Care Hospital | 1430 Hwy4-east, Holly Springs, MS 38635 | 2007-05-29 |
| 1518168624 | Alliance Healthcare System | General Acute Care Hospital | 1430 Hwy 4 East, Holly Springs, MS 38635 | 2007-05-29 |
| 1043427206 | Alliance Healthcare System, Inc | General Acute Care Hospital | 1430 Highway 4 E, Holly Springs, MS 38635-2140 | 2007-05-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.