Provider Demographics
NPI:1912341439
Name:METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-932-9019
Mailing Address - Street 1:1211 UNION AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6600
Mailing Address - Country:US
Mailing Address - Phone:901-516-0721
Mailing Address - Fax:
Practice Address - Street 1:4250 BETHEL RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654
Practice Address - Country:US
Practice Address - Phone:662-932-9000
Practice Address - Fax:662-932-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13-349282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS250167Medicare Oscar/Certification