Provider Demographics
NPI:1639367188
Name:SCOTT REGIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:SCOTT REGIONAL MEDICAL CENTER, INC
Other - Org Name:OCHSNER SCOTT REGIONAL PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:LARKIN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-703-9614
Mailing Address - Street 1:DEPT 3029 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-3029
Mailing Address - Country:US
Mailing Address - Phone:601-213-3010
Mailing Address - Fax:601-213-3011
Practice Address - Street 1:317 HIGHWAY 13 S
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MS
Practice Address - Zip Code:39117-3353
Practice Address - Country:US
Practice Address - Phone:601-732-6301
Practice Address - Fax:601-732-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009013723Medicaid