Provider Demographics
NPI:1538240536
Name:METHODIST EXTENDED CARE HOSPITAL
Entity type:Organization
Organization Name:METHODIST EXTENDED CARE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-2215
Mailing Address - Street 1:225 SOUTH CLAYBROOK
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-516-2152
Mailing Address - Fax:901-516-2022
Practice Address - Street 1:225 SOUTH CLAYBROOK
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-516-2152
Practice Address - Fax:901-516-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000146282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14779409Medicaid
TN0440212Medicaid
MS00220567Medicaid
TN3099538OtherBLUE CROSS
AR152473105Medicaid
TN3155193OtherBLUE CROSS-FEDERAL
TN0440212Medicaid
TN0488760001Medicare NSC