Provider Demographics
NPI:1609830173
Name:BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE INC.
Entity Type:Organization
Organization Name:BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP/ CLO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
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 1:2520 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:662-244-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16253282N00000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000080246OtherBC STATE SNF PROV NUMBER
MS00220136Medicaid
MS000020205OtherBCMS PROVIDER NUMBER
MS00070665Medicaid
AL010052OtherBCAL PROVIDER NUMBER
MS19205OtherBCMS PRO FEE PROV NUMBER
MN000080926OtherBCMS PSYCH PROV NUMBER
MS00550019Medicaid
MS09013691Medicaid
ALBAP0100NMedicaid
ALBAP0100NMedicaid
MS000080246OtherBC STATE SNF PROV NUMBER
MS=========OtherCHAMPUS PROVIDER NUMBER
TN250100Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TN250100Medicare Oscar/Certification