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NPI Code Detail

MEDICARE: BAPTIST-LEAKE EXTENDED CARE FACILITY

MEDICARE: BAPTIST-LEAKE EXTENDED CARE FACILITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility214MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588940811
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAPTIST-LEAKE EXTENDED CARE FACILITY
Provider Business Mailing Address
First Line : 350 N HUMPHREYS BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-2177
Country : US
Telephone Number : 601-267-1432
Fax Number : 601-267-1211
Provider Business Practice Location Address
First Line : 310 ELLIS ST
Second Line :
City : CARTHAGE
State : MS
Zip : 39051-3809
Country : US
Telephone Number : 601-267-1432
Fax Number : 601-267-1211
Authorized Official
Title or Position : SR VP/ CLO
Name : GREGORY M DUCKETT
Credential :
Telephone Number : 901-227-5233
Provider Enumeration Date : 11/01/2011
Last Update Date : 09/30/2020

Similar Medicare Providers

1831174804 — LEAKE COUNTY BOARD OF TRUSTEES
Practice Location Address:
310 ELLIS ST
CARTHAGE, MS
39051-3809
Practice Phone: 601-267-1100
Practice Fax: 601-267-1211
1073545554 — DR. EVAN J. PICKUS M.D.
Practice Location Address:
310 ELLIS ST
CARTHAGE, MS
39051-3809
Practice Phone: 601-740-2785
Practice Fax:
1023187689 — MRS. TOMMIE K JONES C.F.N.P.
Practice Location Address:
310 ELLIS ST
CARTHAGE, MS
39051-3809
Practice Phone: 601-267-1480
Practice Fax: 601-253-0176
1750456034 — LEAKE EXTENDED CARE FACILITY
Practice Location Address:
310 ELLIS ST
CARTHAGE, MS
39051-3809
Practice Phone: 601-267-1100
Practice Fax: 601-267-1211
1194861260 — BAPTIST MEDICAL CENTER-LEAKE, INC.
Practice Location Address:
1100 HWY 16 EAST
CARTHAGE, MS
39051-3809
Practice Phone: 601-267-1470
Practice Fax: 601-267-1469
1891832747 — DR. WILLIAM D LOGAN JR. MD
Practice Location Address:
310 ELLIS ST
CARTHAGE, MS
39051-3809
Practice Phone: 601-267-1100
Practice Fax: 601-267-1191

Directions to “BAPTIST-LEAKE EXTENDED CARE FACILITY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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