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General NPI Number Information
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NPI Number | 1194789818
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Entity Type | Organization
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Legal Business Name | BAPTIST MEMORIAL HOSPITAL-DESOTO, INC,
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 7601 SOUTHCREST PKWY
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4739
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Country | US
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Telephone | 662-349-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 350 N HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2177
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Country | US
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Telephone | 662-349-4000
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Fax |
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Authorized Official
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Title or Position | SR VP/ CLO
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Name | MR. GREGORY M DUCKETT
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Credential |
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Telephone | 901-227-5233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 13318
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License Number State | MS
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