Basic Information
| Provider Information | |||||||||
| NPI: | 1205868627 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TYLER HOLMES MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 TYLER HOLMES DR | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 389671521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622834114 | ||||||||
| FaxNumber: | 6622834640 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 TYLER HOLMES DR | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 389671521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622834114 | ||||||||
| FaxNumber: | 6622834640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | TYLER | ||||||||
| AuthorizedOfficialFirstName: | R | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6622836127 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 000080036 | 01 | MS | BLUE CROSS OF MS-SWBED | OTHER | 000020156 | 01 | MS | BLUE CROSS OF MS-UB | OTHER | 000019156 | 01 | MS | BLUE CROSS OF MS-PRO FEE | OTHER | 00020156 | 05 | MS | MEDICAID |