1821029117 NPI number — TENET HEALTHSYSTEM MEMORIAL MEDICAL CENTER, INC.

Table of content: (NPI 1821029117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821029117 NPI number — TENET HEALTHSYSTEM MEMORIAL MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENET HEALTHSYSTEM MEMORIAL MEDICAL CENTER, 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:
MEMORIAL MEDICAL CENTER
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:
1821029117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 676741
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-6741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-387-6444
Provider Business Mailing Address Fax Number:
504-897-4593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 NAPOLEON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-6914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-899-9311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RABE
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
VP OF TAXATION, TENET HEALTHCARE
Authorized Official Telephone Number:
469-893-2530

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  347 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5516 . This is a "COVENTRY HEALTH CARE LOUI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1744611 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1764248 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61192 . This is a "BCBS OF LOUISIANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 190135B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00020057 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00022050 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000447 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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