Basic Information
| Provider Information | |||||||||
| NPI: | 1881620649 | ||||||||
| 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: | 06/24/2006 | ||||||||
| LastUpdateDate: | 06/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | MOCK | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6014432722 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NATCHEZ REGIONAL MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 11220 | MS | Y | Hospital Units | Rehabilitation Unit |
No ID Information.