GRENADA EMERGENCY GROUP, LLC (NPI# 1194388082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194388082 |
| Entity Type | Organization |
| Organization Name | GRENADA EMERGENCY GROUP, LLC |
| Practice Address |
960 Avent Dr Grenada MS 38901-5230 |
| Mailing Address |
200 Corporate Blvd Lafayette LA 70508-3870 |
| Practice Telephone | 6622277000 |
| Mailing Telephone | 8008939698 |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2019-04-17 |
| Authorized Official Name | LISHA C FALK (VP OF CONTRACTING) |
| Authorized Official Telephone | 8008939698 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
960 AVENT DR |
| City | GRENADA |
| State | MS |
| Zip Code | 38901-5230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386644789 | Grenada Lake Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2005-07-28 |
| 1003431602 | State of Mississippi - University of Mississippi Medical Center | Medicare Defined Swing Bed Unit | 960 Avent Dr, Grenada, MS 38901-5230 | 2020-06-10 |
| 1356961320 | Angelina Guilambo | Physical Therapist | 960 Avent Dr, Grenada, MS 38901-5230 | 2020-04-20 |
| 1841822152 | Shelby Helen Phelon Jackson | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2020-02-05 |
| 1932762721 | Grenada Physician Services, LLC | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2019-04-17 |
| 1013489319 | Kelsey Marter Moncrief | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2018-12-26 |
| 1760908321 | Linda Gail Carter | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2017-08-16 |
| 1528463486 | Marionette Yarbrough | Physical Therapist | 960 Avent Dr, Grenada, MS 38901-5230 | 2014-11-04 |
| 1720419583 | State of Mississippi-university of Mississippi Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2013-12-04 |
| 1639500499 | State of Mississippi-university of Mississippi Medical Center | Durable Medical Equipment & Medical Supplies | 960 Avent Dr, Grenada, MS 38901-5230 | 2013-12-04 |
| Find all providers in the same location | ||||
| 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 | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619292307 | Hubert D Taylor II | Emergency Medicine | 960 Avent Dr, Grenada, MS 38901-5230 | 2010-04-06 |
| 1154359941 | Gary Lou Mason | Emergency Medicine | 960 Avent Dr, Grenada, MS 38901-5230 | 2006-06-29 |
| 1841228012 | Stephen D Butler | Emergency Medicine | 960 Avent Dr, Grenada, MS 38901-5230 | 2006-06-28 |
| 1043246259 | Tarence E Wade | Emergency Medicine | 960 Avent Dr, Grenada, MS 38901-5230 | 2006-06-23 |
| 1306881875 | Dennis W Aust | Emergency Medicine | 960 Avent Dr, Grenada, MS 38901-5230 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780201145 | Sabrina Marie Azavedo | Emergency Medicine | 3283 Shadowood Ln, Corinth, MS 38834-6030 | 2020-07-01 |
| 1275172736 | Relias Emergency Medicine Specialists of West Point, LLC | Emergency Medicine | 150 Medical Center Dr, West Point, MS 39773-0428 | 2020-01-02 |
| 1790130151 | Patrick Bryant | Emergency Medicine | 5001 Hardy Street, Hattiesburg, MS 39402 | 2016-05-04 |
| 1679935381 | Rommel Asagwara | Emergency Medicine | 1060 E County Line Rd Ste 1a, Ridgeland, MS 39157-1937 | 2016-03-22 |
| 1588034227 | Srikar Karanam | Emergency Medicine | 114 Breckenridge Dr Apt 203, Hattiesburg, MS 39402-3709 | 2015-10-06 |
| 1689057721 | John Thames | Emergency Medicine | 1428 Azalea Dr S, Wiggins, MS 39577 | 2015-07-07 |
| 1942612015 | Emergency Associates Pllc | Emergency Medicine | 2660 Ridgewood Rd, Suite 100, Jackson, MS 39216-4921 | 2014-05-23 |
| 1720362270 | David Kennedy Stone | Emergency Medicine | 102 Pine Ct, Brandon, MS 39047-8313 | 2011-10-03 |
| 1083995674 | Obhg Mississippi, P.C. | Emergency Medicine | 1225 N State St Ste B1, Jackson, MS 39202-2072 | 2011-09-09 |
| 1114238425 | Kevin Lee Beason | Emergency Medicine | 10151 Road 1343, Philadelphia, MS 39350-4101 | 2010-07-01 |
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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.