Healthcare Provider Details

I. General information

NPI: 1720117286
Provider Name (Legal Business Name): MISSISSIPPI BAPTIST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

350 N HUMPHREYS BLVD
MEMPHIS TN
38120-2177
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-1362
  • Fax: 601-292-4592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number196
License Number StateMS

VIII. Authorized Official

Name: GREGORY DUCKETT
Title or Position: SR VP/ CLO
Credential:
Phone: 901-227-5233