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DSH250019AV MEMORIAL HOSPITAL AT GULFPORT (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Memorial South Mississippi Nephrology - Biloxi
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019AV
Medicare Provider Number
250019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/11/2013
Last Recertification Date
12/1/2017
Termination Date
Termination Reason
7/1/2018
Site closure
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
784 Vieux Marche
Biloxi, MS 39530
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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