=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346207909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAPTIST MEMORIAL HOSPITAL-UNION CITY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 09/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 BISHOP ST
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38261-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-884-8601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 N HUMPHREYS BLVD
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38120-2177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-884-8601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP/ CLO
-----------------------------------------------------
Name | GREGORY DUCKETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-227-5233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 00000091
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------