NPIMap

Organization Active NPI

South Central Regional Medical Center

Doing business as South Central Dermatology Clinic - Waynesboro

  • Dermatology Physician
  • Waynesboro, MS
National Provider Identifier
1114353539
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Doing business as
South Central Dermatology Clinic - Waynesboro
Practice address
920 Matthew Dr
Suite 8
Waynesboro, MS 39367-2553
Phone
(601) 425-7583
Fax
(601) 399-6281
NPI assigned
Sep 17, 2013
Last updated
Sep 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James T Canizaro
Title
VP of Finance/Cfo
Phone
(601) 399-6139

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

920 Matthew Dr
Suite 8
Waynesboro, MS 39367-2553

Mailing address

PO Box 1649
Laurel, MS 39441-1649
Phone (601) 425-7583

Other names 1

  • South Central Dermatology Clinic - Waynesboro Doing business as

National Provider Directory

National Provider Directory
Tax ID family
South Central Regional Medical Ctr27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

920 Matthew Dr
Ste 8
Waynesboro, MS 39367
Phone (601) 425-7583

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379376000000",
    "number": "1114353539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1649",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394411649",
            "telephone_number": "601-425-7583",
            "fax_number": "601-399-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 MATTHEW DR",
            "address_2": "SUITE 8",
            "city": "WAYNESBORO",
            "state": "MS",
            "postal_code": "393672553",
            "telephone_number": "601-425-7583",
            "fax_number": "601-399-6281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-17",
        "last_updated": "2013-09-17",
        "status": "A",
        "authorized_official_last_name": "CANIZARO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP OF FINANCE/CFO",
        "authorized_official_telephone_number": "601-399-6139"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Central Dermatology Clinic - Waynesboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waynesboro, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.