1386699353 NPI number — BAPTIST MEMORIAL HOSPITAL-JONESBORO INC

Table of content: (NPI 1386699353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386699353 NPI number — BAPTIST MEMORIAL HOSPITAL-JONESBORO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST MEMORIAL HOSPITAL-JONESBORO INC
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:
NEA BAPTIST MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1386699353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 N HUMPHREYS BLVD
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:
38120-2177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
870-936-0101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 E JOHNSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-8413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-936-1000
Provider Business Practice Location Address Fax Number:
870-936-0101
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUCKETT
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP/ CLO
Authorized Official Telephone Number:
901-227-5233

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 4183 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 192756105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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