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General NPI Number Information
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NPI Number | 1255882890
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI BAPTIST MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 1225 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39202-2064
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Country | US
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Telephone | 601-968-6350
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Fax | 601-968-6351
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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 |
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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 | 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 | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 15022/1.1
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License Number State | MS
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