1609830173 NPI number — BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609830173 NPI number — BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE INC.

Employer Identification Number (EIN):

Provider Organization Name:

BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE 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 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:

1609830173

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/10/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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:

Provider First Line Business Practice Location Address:

2520 5TH ST N

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

COLUMBUS

Provider Business Practice Location Address State Name:

MS

Provider Business Practice Location Address Postal Code:

39705-2008

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

662-244-1500

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/13/2006

Authorized Official Last Name:

DUCKETT

Authorized Official First Name:

GREGORY

Authorized Official Middle Name:

Authorized Official Title or Position:

SR VP/ CLO

Authorized Official Telephone Number:

901-227-5233

• Taxonomy code: 282N00000X , with the licence number:  16253 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 000080246 . This is a "BC STATE SNF PROV NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
• Identifier: 00220136 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 000020205 . This is a "BCMS PROVIDER NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
• Identifier: 00070665 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 010052 . This is a "BCAL PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 19205 . This is a "BCMS PRO FEE PROV NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
• Identifier: 000080926 . This is a "BCMS PSYCH PROV NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 00550019 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 09013691 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: BAP0100N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".