Provider Demographics
NPI:1275217606
Name:NORTHWEST MISS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTHWEST MISS REGIONAL MEDICAL CENTER
Other - Org Name:NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERM CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CHFP
Authorized Official - Phone:662-627-3211
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1218
Mailing Address - Country:US
Mailing Address - Phone:662-627-3211
Mailing Address - Fax:662-624-3214
Practice Address - Street 1:1970 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7202
Practice Address - Country:US
Practice Address - Phone:662-627-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital