Organization
BAPTIST MEDICAL CENTER-LEAKE, INC
Active
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.
Other names
BMC Leake Walnut Grove Primary Care
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
110 PARK ST, WALNUT GROVE, MS 39189-6526
(601) 267-1400
Mailing address
350 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2177
(601) 267-1400
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115309
—
MS
05
—
0123601
—
MS
Enumeration date
01/11/2007
Last updated
09/30/2020
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