Provider Demographics
NPI:1649224452
Name:BAPTIST MEMORIAL REGIONAL REHABILITATIVE SERVICES INC
Entity Type:Organization
Organization Name:BAPTIST MEMORIAL REGIONAL REHABILITATIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRALKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-757-3439
Mailing Address - Street 1:1111 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6646
Mailing Address - Country:US
Mailing Address - Phone:901-529-4045
Mailing Address - Fax:
Practice Address - Street 1:1111 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6646
Practice Address - Country:US
Practice Address - Phone:901-529-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4064897OtherBCTN PROVIDER NUMBER
TN4064897OtherBCTN PROVIDER NUMBER