Provider Demographics
NPI:1679831531
Name:SCOTT REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SCOTT REGIONAL MEDICAL CENTER, INC.
Other - Org Name:OCHSNER HEALTH CENTER- FOREST
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 1:1080 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-9423
Practice Address - Country:US
Practice Address - Phone:601-469-3555
Practice Address - Fax:601-469-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS002838364Medicaid