Provider Demographics
NPI:1073759494
Name:ANDERSON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ANDERSON REGIONAL MEDICAL CENTER
Other - Org Name:ANDERSON REGIONAL MEDICAL CENTER SOUTH CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARTSILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-553-6104
Mailing Address - Street 1:2124 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4040
Mailing Address - Country:US
Mailing Address - Phone:601-553-6000
Mailing Address - Fax:601-553-6848
Practice Address - Street 1:1102 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4001
Practice Address - Country:US
Practice Address - Phone:601-553-6647
Practice Address - Fax:601-553-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03178Medicare UPIN