Mississippi Baptist Medical Center, INC.
Psychologist in Jackson, MS. Organization (NPI-2).
NPI number1124155809
StatusActive
Last updated in NPPESSep 30, 2020
Details
- NPI
- 1124155809
- Entity type
- Organization (NPI-2)
- Legal business name
- Mississippi Baptist Medical Center, INC.
- Organization subpart
- Yes
- Enumeration date
- Feb 28, 2007
- Certification date
- Sep 30, 2020
- Last updated
- Sep 30, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | – | – | Yes |
| 367500000X | Nurse Anesthetist, Certified Registered | – | – |
Other names
- Mississippi Baptist Medical Center Railroad Medicare (Doing Business As)
Practice location
1225 N State StJackson, MS 39202-2064
Phone 601-968-1362 · Fax 601-292-4592
Mailing address
350 N Humphreys BlvdMemphis, TN 38120-2177
Authorized official
Gregory M Duckett
Sr Vp/ Clo
9012275233
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