1538240536 NPI number — METHODIST EXTENDED CARE HOSPITAL

Table of content: (NPI 1538240536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538240536 NPI number — METHODIST EXTENDED CARE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHODIST EXTENDED CARE HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
METHODIST EXTENDED CARE HOSPITAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538240536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 SOUTH CLAYBROOK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-516-2152
Provider Business Mailing Address Fax Number:
901-516-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 SOUTH CLAYBROOK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-516-2152
Provider Business Practice Location Address Fax Number:
901-516-2022
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
901-516-2215

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  0000000146 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14779409 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440212 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00220567 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3099538 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 152473105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3155193 . This is a "BLUE CROSS-FEDERAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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