Provider Demographics
NPI:1053346635
Name:TENET HEALTHSYSTEM MEMORIAL MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:TENET HEALTHSYSTEM MEMORIAL MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF TAXATION, TENET HEALTHCARE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2530
Mailing Address - Street 1:PO BOX 676741
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6741
Mailing Address - Country:US
Mailing Address - Phone:214-387-6444
Mailing Address - Fax:504-483-5104
Practice Address - Street 1:2700 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6914
Practice Address - Country:US
Practice Address - Phone:504-899-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA347273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
19-T135Medicare ID - Type UnspecifiedREHAB