NPIMap

Organization Active NPI

South Central Regional Medical Center

Doing business as Laurel Pediatric Clinic

  • Pediatric Adolescent Medicine Physician
  • Laurel, MS
National Provider Identifier
1821342379
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Doing business as
Laurel Pediatric Clinic
Practice address
234 S 12TH Ave
Laurel, MS 39440-4325
Phone
(601) 649-3520
Fax
(601) 649-7899
NPI assigned
Nov 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

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

Authorized official

Name
Mr. James T Canizaro
Title
Vice President/ C.F.O.
Phone
(601) 399-6139

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

234 S 12TH Ave
Laurel, MS 39440-4325

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
08705378MedicaidMS

Other names 1

  • Laurel Pediatric Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
South Central Regional27 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

NPI Registry JSON

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1821342379",
    "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": "234 S 12TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404325",
            "telephone_number": "601-649-3520",
            "fax_number": "601-649-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "CANIZARO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT/ C.F.O.",
        "authorized_official_telephone_number": "601-399-6139",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08705378",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 6, 2012; 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.