Provider Demographics
NPI:1720080823
Name:BAPTIST-EMSC LP
Entity Type:Organization
Organization Name:BAPTIST-EMSC LP
Other - Org Name:EAST MEMPHIS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/ CLO
Authorized Official - Prefix:MR
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 1:80 HUMPHREYS CTR
Mailing Address - Street 2:STE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2352
Mailing Address - Country:US
Mailing Address - Phone:901-747-3233
Mailing Address - Fax:901-747-3230
Practice Address - Street 1:80 HUMPHREYS CTR
Practice Address - Street 2:STE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2352
Practice Address - Country:US
Practice Address - Phone:901-747-3233
Practice Address - Fax:901-747-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000040261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3287497Medicare ID - Type Unspecified