NPIMap

Organization Active NPI

South Central Regional Medical Ctr

  • Internal Medicine Physician
  • Laurel, MS
National Provider Identifier
1396920484
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11-153 Issued in MS
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CTR
Practice address
1220 Jefferson St
Laurel, MS 39440-4355
Phone
(601) 426-4000
NPI assigned
Jan 8, 2008
Organization subpart
Yes
Parent organization
SOUTH CENTRAL REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

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

Authorized official

Name
Stephen East
Title
Cfo
Phone
(601) 399-6144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 11-153 MS Primary

Addresses

Primary practice location

1220 Jefferson St
Laurel, MS 39440-4355

Mailing address

PO Box 607
Laurel, MS 39441-0607
Phone (601) 399-6103

Other identifiers 1

IdentifierTypeStateIssuer
09013316MedicaidMS

Other names 1

  • South Central Regional Medical Ctr-EEG Other name

National Provider Directory

National Provider Directory
Tax ID family
South Central Reg Med C27 organizations share this tax ID, including this one
Part of
South Central Reg Med C

Other organizations with this tax ID 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752192000000",
    "number": "1396920484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410607",
            "telephone_number": "601-399-6103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404355",
            "telephone_number": "601-426-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL MEDICAL CTR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "enumeration_date": "2008-01-08",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-399-6144"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "11-153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013316",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Central Regional Medical Ctr-EEG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2025; 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.