Provider Demographics
NPI:1295849578
Name:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Entity type:Organization
Organization Name:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:POUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-227-7463
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:901-227-7463
Mailing Address - Fax:901-227-5699
Practice Address - Street 1:2301 S LAMAR BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5373
Practice Address - Country:US
Practice Address - Phone:662-513-3246
Practice Address - Fax:662-513-6248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09274328Medicaid
MS09274328Medicaid
MS09274328Medicaid