Provider Demographics
NPI:1205868627
Name:TYLER HOLMES MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:TYLER HOLMES MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-283-4114
Mailing Address - Street 1:409 TYLER HOLMES DR
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-1521
Mailing Address - Country:US
Mailing Address - Phone:662-283-4114
Mailing Address - Fax:662-283-4640
Practice Address - Street 1:409 TYLER HOLMES DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-1521
Practice Address - Country:US
Practice Address - Phone:662-283-4114
Practice Address - Fax:662-283-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000113703Medicaid
MS007870552Medicaid
MS00020156Medicaid
MS000020156OtherBLUE CROSS OF MS-UB
MS000019156OtherBLUE CROSS OF MS-PRO FEE
MS000015590Medicaid
MS000080036OtherBLUE CROSS OF MS-SWBED