Scott Regional Medical Center, Inc
Organization Active NPI Emergency Medicine Physician · Morton, MS
NPI 1639367188 · NPPES record last updated Apr 17, 2025
Key facts
- NPI
- 1639367188
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- SCOTT REGIONAL MEDICAL CENTER, INC
- Practice address
- 317 Highway 13 S
Morton, MS 39117-3353 - Phone
- (601) 732-6301
- Fax
- (601) 732-6476
- NPI assigned
- Oct 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Don Larkin Kennedy
- Title
- Regional Ceo
- Phone
- (601) 703-9614
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 4
Practitioners 58
-
Sierra Cain, NP-C
-
Martin Wayne Carr, FNP
-
Brandon J Craft, NP
-
Jessica Derrick, FNP-C
-
Connie J Gainey, FNP BC
-
Lisa Michelle Gant, FNP
-
Patsy Lenan Holloway, FNP BC
-
Melissa B Jackson, FNP
-
Norman Jenkins, FNP
-
Matthew B Bentley, D.O.
-
Erica A Diggs, MD
-
Rehmat Ullah Awan, M.B,B.S , MD
-
Glenda R. Barrett, FNP
-
Bret A Boes, M.D.
-
Melissa D. Campbell, M.D.
-
Andrew Daughton Chambers, FNP-BC
-
Evan Ciarloni, MD
-
Matthew Thomas Copeland, FNP-C
-
Jason Defatta, D.O.
-
Spencer Dickerson, CRNA
-
Frederick T Duggan, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080423000448 | MS | Part B Supplier - Clinic/Group Practice | 0648366260 |
Receives reassigned benefits from 57 practitioners 3 other NPIs on this enrollment Practice locations: Forest, MS; Lake, MS; Morton, MS |
National Provider Directory
Locations
14365 Highway 16 W
De Kalb, MS 39328
Phone (769) 486-1000
1080 Highway 35 S
Forest, MS 39074
Phone (601) 469-3555
317 Old Highway 13 S
Morton, MS 39117
Phone (601) 732-1057
25117 Highway 15
Union, MS 39365
Phone (601) 774-8214
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X | |||
| Certified Registered Nurse Anesthetist |
367500000X |
Addresses
Primary practice location
317 Highway 13 S
Morton, MS 39117-3353
Mailing address
Dept 3029 PO Box 1000
Memphis, TN 38148-3029
Phone (601) 213-3010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009013723 | Medicaid | MS |
Other names
- Ochsner Scott Regional Professional Services
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Morton, MS
- Hannah Ashley Poole
- Jamie Renee Rawson
- Ross Dental Clinic P.C.
- Jamie Eichelberger Ross
- Scott County LTC, Inc.
- Scott Regional Medical Center, Inc.
- Scott Regional Medical Center, Inc.
- Scott Regional Medical Center, Inc.
- Ashley Murphy Shivers
- Sitting Angels Customized Senior Care
All providers in Morton, MS · Emergency Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.