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DSH250019JN MEMORIAL HOSPITAL AT GULFPORT (Active)
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Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics Cedar Lake Multispecialty- Women's Health
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019JN
Medicare Provider Number
250019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/5/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/10/2024
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Memorial Hospital at Gulfport
Kent Nicaud, President and Chief Executive Officer
(228) 867-4046
Primary Contact
Memorial Hospital at Gulfport
Brian Clark, Outpatient Pharmacy Director
(228) 867-4485
Addresses
Street Address
1756 POPPS FERRY RD
STE A
BILOXI, MS 39532-2118
Billing Address
Memorial Hospital at Gulfport
4500 13th Street
Gulfport, MS 39501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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