Provider Demographics
| NPI: | 1306089206 |
|---|---|
| Name: | BAPTIST MEMORIAL MEDICAL GROUP INC |
| Entity type: | Organization |
| Organization Name: | BAPTIST MEMORIAL MEDICAL GROUP INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | SR VP/CLO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | GREGORY |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | DUCKETT |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 901-227-5233 |
| Mailing Address - Street 1: | 350 N HUMPHREYS BLVD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MEMPHIS |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 38120-2177 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 8970 WINCHESTER RD |
| Practice Address - Street 2: | |
| Practice Address - City: | MEMPHIS |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 38125-8231 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 901-227-4068 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | BAPTIST MEMORIAL HEALTH CARE CORP. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2009-04-08 |
| Last Update Date: | 2020-10-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty |
