GRENADA LAKE MEDICAL CENTER (NPI# 1154506277) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154506277 |
| Entity Type | Organization |
| Organization Name | GRENADA LAKE MEDICAL CENTER |
| Other Organization Name | GRENADA PRIMARY CARE CLINIC |
| Practice Address |
965 Avent Dr Ste 105 Grenada MS 38901-5045 |
| Practice Telephone | 6622277575 |
| Mailing Telephone | 6622277575 |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-08 |
| Authorized Official Name | MR. CHARLES L DENTON (CEO) |
| Authorized Official Telephone | 6622277005 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
11-245 | MS | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Grenada Primary Care Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053684548 | Grenada Lake Medical Center | Family Medicine | 965 Avent Dr Ste 100a, Grenada, MS 38901-5045 | 2012-02-15 |
| 1922187095 | Grenada Lake Medical Center | Orthopaedic Surgery | 960 J K Avent Dr, Grenada, MS 38901-5230 | 2006-11-02 |
| 1386644789 | Grenada Lake Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2005-07-28 |
| 1699005355 | Grenada Lake Medical Center | Ambulance | 960 Avent Dr, Grenada, MS 38901-5230 | 2009-12-31 |
| 1467781377 | Grenada Lake Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2009-12-24 |
| 1215165642 | Grenada Lake Medical Center | Psychiatric Unit | 960 Avent Dr, Grenada, MS 38901-5230 | 2009-06-24 |
| 1134302136 | Grenada Lake Medical Center | General Acute Care Hospital | 965 Avent Dr Ste 105, Grenada, MS 38901-5045 | 2007-12-12 |
| 1790849354 | Grenada Lake Medical Center | General Acute Care Hospital | 960 J K Avent Dr, Grenada, MS 38901 | 2006-12-20 |
| 1326109505 | Grenada Lake Medical Center | General Acute Care Hospital | 960 J K Avent Dr, Grenada, MS 38901 | 2006-12-12 |
| 1669578894 | Grenada Lake Medical Center | Obstetrics & Gynecology | 1900 Grandview Dr, Grenada, MS 38901-5066 | 2006-09-15 |
| Street Address |
965 AVENT DR STE 105 |
| City | GRENADA |
| State | MS |
| Zip Code | 38901-5045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720057565 | Cynthia C Dotson | Nurse Practitioner | 965 Avent Dr Ste 105, Grenada, MS 38901-5045 | 2006-03-15 |
| 1134302136 | Grenada Lake Medical Center | General Acute Care Hospital | 965 Avent Dr Ste 105, Grenada, MS 38901-5045 | 2007-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902435118 | The Mane Physician | Prosthetic/Orthotic Supplier | 94 Spain Drive, Grenada, MS 38901 | 2020-04-08 |
| 1942842166 | Sylvia C Bass | Technician | 813 Union Street, Grenada, MS 38901 | 2019-10-09 |
| 1669971180 | Jenny Taylor | Nurse Practitioner | 350 Sunset Drive, Grenada, MS 38901 | 2018-02-10 |
| 1073912762 | John Thomas Mcree I | Counselor | 2026 Commerce St Ste 8e, Grenada, MS 38901 | 2014-08-19 |
| 1700213634 | State of Mississippi-university of Mississippi Medical Center | Home Health | 960 Avent Drive, Grenada, MS 38901 | 2013-10-10 |
| 1114359866 | Cmhp Enterprises | Dentist | 1420 Wooded Drive, Grenada, MS 38901 | 2013-08-05 |
| 1518256460 | Mercy Hospice LLC | Hospice Care, Community Based | 1410 Wooded Drive, Grenada, MS 38901 | 2011-03-31 |
| 1215256318 | Della Lea Welsh | Speech-Language Pathologist | 1321 Dd Sunset Dr., Grenada, MS 38901 | 2010-05-28 |
| 1750514543 | Family Health Care Clinic, Inc. | Clinic/Center | 1102 Telegraph St, Grenada, MS 38901 | 2009-08-27 |
| 1033384771 | Jason K Bennett | Pharmacist | 140 Shadow Wood Cv, Grenada, MS 38901 | 2008-04-24 |
| Find all providers in zip 38901 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528495454 | State of Mississippi-university of Mississippi Medical Center | Clinic/Center | 965 Avent Dr Ste 107, Grenada, MS 38901-5045 | 2013-10-10 |
| 1447264882 | Physicians and Surgeons | Clinic/Center | 1732 Commerce St, Grenada, MS 38901-4615 | 2006-07-29 |
| 1821525957 | State of Mississippi - University of Mississippi Medical Center | Clinic/Center | 1300 Sunset Dr Ste F, Grenada, MS 38901-4083 | 2017-05-19 |
| 1013032150 | Woman's Health Clinic of Grenada, Inc | Clinic/Center | 1401 Oak St, Grenada, MS 38901-4633 | 2007-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730786120 | Ochsner Medical Center - Hancock, LLC | Clinic/Center | 2274 Highway 43 S Ste 200, Picayune, MS 39466-8141 | 2020-10-08 |
| 1306460282 | Covington County Hospital | Clinic/Center | 105 Eaton St, Taylorsville, MS 39168-5614 | 2020-06-05 |
| 1871117747 | Covington County Hospital | Clinic/Center | 1039 Highway 42 Ste C, Sumrall, MS 39482-4478 | 2020-06-05 |
| 1194365338 | Bounds Family Medical | Clinic/Center | 870 Main St Ste A, Fayette, MS 39069-5695 | 2020-01-15 |
| 1720649577 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 19 Third St, Belmont, MS 38827 | 2019-06-24 |
| 1255999611 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 400 3rd Ave 32 West, New Houlka, MS 38850 | 2019-05-31 |
| 1598238545 | South Sunflower County Hospital | Clinic/Center | 1001 West Delta, Moorhead, MS 38761 | 2019-01-02 |
| 1790272185 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 670 Ms-178, Suite 5, Sherman, MS 38869 | 2018-04-20 |
| 1124515515 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 2200 5th St N, Columbus, MS 39705-2212 | 2018-04-20 |
| 1205323698 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 815 2nd Ave N, Columbus, MS 39701-4703 | 2018-04-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.