Provider Demographics
NPI:1821029117
Name:TENET HEALTHSYSTEM MEMORIAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:TENET HEALTHSYSTEM MEMORIAL MEDICAL CENTER, INC.
Other - Org Name:MEMORIAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF TAXATION, TENET HEALTHCARE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2530
Mailing Address - Street 1:PO BOX 676741
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6741
Mailing Address - Country:US
Mailing Address - Phone:214-387-6444
Mailing Address - Fax:504-897-4593
Practice Address - Street 1:2700 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6914
Practice Address - Country:US
Practice Address - Phone:504-899-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA347282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
5516OtherCOVENTRY HEALTH CARE LOUI
LA1744611Medicaid
LA1764248Medicaid
61192OtherBCBS OF LOUISIANA
190135B000000OtherSECTION 1011
MS00020057Medicaid
MS00022050Medicaid
000447OtherHUMANA
000447OtherHUMANA