Provider Demographics
NPI:1245260900
Name:NATCHEZ REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:NATCHEZ REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-443-2600
Mailing Address - Street 1:PO BOX 14149
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4149
Mailing Address - Country:US
Mailing Address - Phone:225-924-9827
Mailing Address - Fax:225-924-9829
Practice Address - Street 1:46 SGT PRENTISS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-443-2100
Practice Address - Fax:601-443-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015592Medicaid
MSC02624Medicare ID - Type UnspecifiedMEDICARE GROUP
MS09015592Medicaid
MSC00037Medicare PIN