Provider Demographics
NPI:1497879076
Name:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Entity Type:Organization
Organization Name:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:POUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-227-7463
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:901-227-7463
Mailing Address - Fax:901-227-5699
Practice Address - Street 1:2520 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2008
Practice Address - Country:US
Practice Address - Phone:662-244-2042
Practice Address - Fax:662-244-2041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00355585Medicaid
MSC03452Medicare PIN