Provider Demographics
NPI:1588644348
Name:BAPTIST MEMORIAL HOSPITAL-CALHOUN INC
Entity Type:Organization
Organization Name:BAPTIST MEMORIAL HOSPITAL-CALHOUN INC
Other - Org Name:BAPTIST MEMORIAL HOSPITAL-CALHOUN
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:662-628-6611
Mailing Address - Fax:662-628-6610
Practice Address - Street 1:140 BURKE CALHOUN CITY RD
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-9690
Practice Address - Country:US
Practice Address - Phone:662-628-6611
Practice Address - Fax:662-628-6610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00378/3.1333600000X
3336C0003X, 3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169530OtherPK
MS00020213Medicaid
MS00Z0Z13Medicaid
9013122OtherER PHYSICIAN
250112Medicare Oscar/Certification
250112Medicare ID - Type Unspecified