Provider Demographics
NPI:1598803926
Name:MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Other - Org Name:METHODIST REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-981-2611
Mailing Address - Street 1:1350 E WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5112
Mailing Address - Country:US
Mailing Address - Phone:601-981-2611
Mailing Address - Fax:
Practice Address - Street 1:1607 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6027
Practice Address - Country:US
Practice Address - Phone:318-410-0846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS43-278332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040292Medicaid
MS00040292Medicaid