Provider Demographics
NPI:1235553066
Name:BAPTIST MEMORIAL REHABILITATION HOSPITAL, GP
Entity Type:Organization
Organization Name:BAPTIST MEMORIAL REHABILITATION HOSPITAL, GP
Other - Org Name:BAPTIST MEMORIAL REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
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 1:1240 SOUTH GERMANTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2226
Mailing Address - Country:US
Mailing Address - Phone:901-237-2314
Mailing Address - Fax:
Practice Address - Street 1:1240 SOUTH GERMANTOWN ROAD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2226
Practice Address - Country:US
Practice Address - Phone:901-237-2314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital