Provider Demographics
NPI:1053375576
Name:BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INC
Entity type:Organization
Organization Name:BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP/CLO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-227-5233
Mailing Address - Street 1:350 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 BELK BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5242
Practice Address - Country:US
Practice Address - Phone:662-636-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16228282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000020180OtherMS BC PROV NUMBER
MS000019180OtherBC PRO FEE PROV NUMBER
MS000080241OtherBC SNF PROV NUMBER
MS00020016Medicaid
MS09012211Medicaid
MN00050026Medicaid
MS=========OtherCHAMPUS
MS09012211Medicaid
MS000080241OtherBC SNF PROV NUMBER