Provider Demographics
NPI:1376729442
Name:BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INC
Entity Type:Organization
Organization Name:BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INC
Other - Org Name:BMH NORTH MS
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 1:350 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 1:126 HIGHWAY 51 N
Practice Address - Street 2:P O BOPX 1429
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2347
Practice Address - Country:US
Practice Address - Phone:662-578-8402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-18
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6781251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS80770241Medicaid
70648OtherBLUE CROSS MS
TN257114Medicare Oscar/Certification