Provider Demographics
NPI:1659494359
Name:REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYE
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-545-6262
Mailing Address - Street 1:2991 WOOD THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3155
Mailing Address - Country:US
Mailing Address - Phone:901-388-6648
Mailing Address - Fax:901-545-7177
Practice Address - Street 1:880 MADISON AVE
Practice Address - Street 2:SUITE 5BOL
Practice Address - City:MEMPHIS
Practice Address - State:NE
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-545-6262
Practice Address - Fax:901-545-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006000282NC0060X
TN000006000282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMB1241342OtherDEA NUMBER