Provider Demographics
NPI:1871232355
Name:SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Other - Org Name:EMPLOYEE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-249-1806
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-250-4324
Mailing Address - Fax:601-250-4325
Practice Address - Street 1:200 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2706
Practice Address - Country:US
Practice Address - Phone:601-250-4324
Practice Address - Fax:601-250-4325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care