Provider Demographics
NPI:1104971696
Name:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Entity type:Organization
Organization Name:BAPTIST MEMORIAL HEALTH SERVICES, INC. OF MISSISSIPPI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:POUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-227-7463
Mailing Address - Street 1:200 STATE HIGHWAY 30 W
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3112
Mailing Address - Country:US
Mailing Address - Phone:662-538-2425
Mailing Address - Fax:662-538-2593
Practice Address - Street 1:200 STATE HIGHWAY 30 W
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3112
Practice Address - Country:US
Practice Address - Phone:662-538-2425
Practice Address - Fax:662-538-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02933268Medicaid
MS02933268Medicaid