Provider Demographics
NPI:1962780379
Name:MEMORIAL HOSPITAL AT GULFPORT
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL AT GULFPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN BUSINESS SERVICES DIR.
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CPC
Authorized Official - Phone:228-575-1740
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533-0555
Mailing Address - Country:US
Mailing Address - Phone:228-865-1453
Mailing Address - Fax:228-865-1457
Practice Address - Street 1:4500 13TH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2515
Practice Address - Country:US
Practice Address - Phone:228-865-3451
Practice Address - Fax:228-867-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty