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DSH250019FN MEMORIAL HOSPITAL AT GULFPORT (Active)
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Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Pascagoula Multispecialty Clinic - Neurology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019FN
Medicare Provider Number
250019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/9/2019
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
4603 Hospital Road
Pascagoula, MS 39581
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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