1558365890 NPI number — METHODIST HEALTHCARE - MEMPHIS HOSPITALS

Table of content: (NPI 1558365890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558365890 NPI number — METHODIST HEALTHCARE - MEMPHIS HOSPITALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHODIST HEALTHCARE - MEMPHIS HOSPITALS
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:
1558365890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 UNION AVE
Provider Second Line Business Mailing Address:
STE 700
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38104-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-516-0753
Provider Business Mailing Address Fax Number:
901-516-0699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 UNION AVE
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:
38104-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-516-7000
Provider Business Practice Location Address Fax Number:
901-516-0699
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LANE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
901-516-0962

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000109 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC2000X , with the licence number: 0000000109 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 072829701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4400049 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1738051 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4687470 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01620160 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: UM01972847 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 096711400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100106430 B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107115105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 322834 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010852713 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440049 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0902965 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 442306 . This is a "MEDICARE PROVIDER NUMBER - TRANSPLANT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4687460 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MET0049N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00020469 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100034980A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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