Provider Demographics
NPI:1558365890
Name:METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-0962
Mailing Address - Street 1:1211 UNION AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6600
Mailing Address - Country:US
Mailing Address - Phone:901-516-0753
Mailing Address - Fax:901-516-0699
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-516-7000
Practice Address - Fax:901-516-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000109282N00000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX072829701Medicaid
NC4400049Medicaid
LA1738051Medicaid
MI4687470Medicaid
KY01620160Medicaid
COUM01972847Medicaid
FL096711400Medicaid
KS100106430 BMedicaid
AR107115105Medicaid
AZ322834Medicaid
MO010852713Medicaid
TN0440049Medicaid
IA0902965Medicaid
TN442306OtherMEDICARE PROVIDER NUMBER - TRANSPLANT
MI4687460Medicaid
ALMET0049NMedicaid
MS00020469Medicaid
IN100034980AMedicaid
IN100034980AMedicaid
MI4687460Medicaid