1396709978 NPI number — BAPTIST MEMORIAL HOSPITAL-BOONEVILLE, INC.

Table of content: (NPI 1396709978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396709978 NPI number — BAPTIST MEMORIAL HOSPITAL-BOONEVILLE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST MEMORIAL HOSPITAL-BOONEVILLE, 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:
Provider Other Organization Name Type Code:
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:
1396709978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2021
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:
901-227-4133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONEVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38829-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-720-5004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  16161 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000020084 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00029003 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00020084 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: C00181 . This is a "MEDICARE PROF FEE PROV NU" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00250044 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9013631 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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