Basic Information
| Provider Information | |||||||||
| NPI: | 1831113240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATCHEZ REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 SEARGENT S PRENTISS DR | ||||||||
| Address2: | |||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014432100 | ||||||||
| FaxNumber: | 6014432885 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 SEARGENT S PRENTISS DR | ||||||||
| Address2: | |||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014432100 | ||||||||
| FaxNumber: | 6014432885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WESSELMAN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6014432600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 11220 | MS | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 163W00000X | 11220 | MS | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 09013403 | 05 | MS | MEDICAID |