Provider Demographics
NPI:1447364849
Name:ANDERSON REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ANDERSON REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP / CLO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-227-5233
Mailing Address - Street 1:2024 15TH ST
Mailing Address - Street 2:FIRST FLOOR MEDICAL TOWERS
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4130
Mailing Address - Country:US
Mailing Address - Phone:601-483-4221
Mailing Address - Fax:601-693-8421
Practice Address - Street 1:2024 15TH ST
Practice Address - Street 2:FIRST FLOOR MEDICAL TOWERS
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4130
Practice Address - Country:US
Practice Address - Phone:601-483-4221
Practice Address - Fax:601-693-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X
MS00698/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0030572Medicaid
MS2514570OtherRETAIL PHARMACY-NABP NO.
MS2514570Medicare ID - Type UnspecifiedRETAIL PHARMACY
MS0129350001Medicare NSC