Healthcare Provider Details

I. General information

NPI: 1457163156
Provider Name (Legal Business Name): BAPTIST MEMORIAL REHABILITATION HOSPITAL - MADISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 HIGHLAND COLONY PKWY
MADISON MS
39110
US

IV. Provider business mailing address

330 SEVEN SPRINGS WAY
BRENTWOOD TN
37027-5098
US

V. Phone/Fax

Practice location:
  • Phone: 601-906-0278
  • Fax:
Mailing address:
  • Phone: 615-920-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: JAMES NATHAN BUCKALEW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-906-0278