1619918075 NPI number — BAPTIST MEDICAL CENTER - YAZOO, INC

Table of content: (NPI 1619918075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619918075 NPI number — BAPTIST MEDICAL CENTER - YAZOO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST MEDICAL CENTER - YAZOO, 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:
KING'S DAUGHTERS HOSPITAL OF YAZOO COUNTY, INC.
Provider Other Organization Name Type Code:
4
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:
1619918075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2020
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
823 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAZOO CITY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39194-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-746-2261
Provider Business Practice Location Address Fax Number:
662-746-4839
Provider Enumeration Date:
06/09/2006

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: 282NC0060X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000020082 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20253 . This is a "BCBS HOSPITAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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