Provider Demographics
NPI:1982988812
Name:BAPTIST PT - MADISON
Entity Type:Organization
Organization Name:BAPTIST PT - MADISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-944-1717
Mailing Address - Street 1:401 BAPTIST DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-2009
Mailing Address - Country:US
Mailing Address - Phone:601-607-7204
Mailing Address - Fax:601-607-7430
Practice Address - Street 1:401 BAPTIST DR
Practice Address - Street 2:SUITE 306
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2009
Practice Address - Country:US
Practice Address - Phone:601-607-7204
Practice Address - Fax:601-607-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty