Provider Demographics
NPI:1881142461
Name:BAPTIST MEMORIAL HOSPITAL-CALHOUN INC
Entity type:Organization
Organization Name:BAPTIST MEMORIAL HOSPITAL-CALHOUN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP/CORP SECRETARY
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 1:350 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:662-628-6611
Mailing Address - Fax:662-628-6300
Practice Address - Street 1:140 BURKE CALHOUN CITY RD
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-9690
Practice Address - Country:US
Practice Address - Phone:662-628-6611
Practice Address - Fax:662-628-6300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-13
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-259282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS19976OtherBLUE CROSS MS
MS00029213Medicaid
MS20976OtherBLUE CROSS MS
MS05725275Medicaid
MS09013122Medicaid
MS00020213Medicaid
MS00553332Medicaid
MS05725275Medicaid
MS00029213Medicaid