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Organization
BAPTIST MEMORIAL HOSPITAL-BOONEVILLE, INC.
Active
Organization
BAPTIST MEMORIAL HOSPITAL-BOONEVILLE, INC.
Active
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BAPTIST MEMORIAL HEALTH CARE CORP.
Authorized official
GREGORY M DUCKETT (SR VP/ CLO)
(901) 227-5233
Entity
Organization
Contact information
Practice address
100 HOSPITAL ST, BOONEVILLE, MS 38829-3354
(662) 720-5004
Mailing address
350 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2177
(901) 227-4133
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
16161
MS
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000020084
BLUE CROSS PROVIDER NUMBE
MS
05
—
00020084
—
MS
05
—
00029003
—
MS
05
—
00250044
—
TN
05
—
9013631
—
MS
01
—
C00181
MEDICARE PROF FEE PROV NU
MS
Enumeration date
04/12/2006
Last updated
09/16/2021
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