GRENADA LAKE MEDICAL CENTER (NPI# 1326109505) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326109505 |
| Entity Type | Organization |
| Organization Name | GRENADA LAKE MEDICAL CENTER |
| Practice Address |
960 J K Avent Dr Grenada MS 38901 |
| Practice Telephone | 6622277000 |
| Practice Fax Number | 6622276538 |
| Mailing Telephone | 6622277000 |
| Mailing Fax Number | 6622276538 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2012-08-10 |
| Authorized Official Name | MR. CHARLES L DENTON (CEO) |
| Authorized Official Telephone | 6622277000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 11-245 | MS | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | BX PROF FEE # | 000019026 | 01 |
| MS | 09011014 | 05 |
| 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 |
| 1154506277 | Grenada Lake Medical Center | Clinic/Center | 965 Avent Dr Ste 105, Grenada, MS 38901-5045 | 2008-01-08 |
| 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 |
| 1669578894 | Grenada Lake Medical Center | Obstetrics & Gynecology | 1900 Grandview Dr, Grenada, MS 38901-5066 | 2006-09-15 |
| Street Address |
960 J K AVENT DR |
| City | GRENADA |
| State | MS |
| Zip Code | 38901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922187095 | Grenada Lake Medical Center | Orthopaedic Surgery | 960 J K Avent Dr, Grenada, MS 38901-5230 | 2006-11-02 |
| 1780015396 | State of Mississippi-university of Mississippi Medical Center | Ambulance | 960 J K Avent Dr, Grenada, MS 38901-5230 | 2013-12-06 |
| 1235284928 | Grenada Lake Inpatient Medicine Associates | Internal Medicine | 960 J K Avent Dr, Grenada, MS 38901-5230 | 2007-01-24 |
| 1255496881 | Lewis Wesley Keen Jr. | Registered Nurse | 960 J K Avent Dr, Grenada, MS 38901-5230 | 2006-12-26 |
| 1790849354 | Grenada Lake Medical Center | General Acute Care Hospital | 960 J K Avent Dr, Grenada, MS 38901 | 2006-12-20 |
| 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 | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720419583 | State of Mississippi-university of Mississippi Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2013-12-04 |
| 1558798603 | State of Mississippi-university of Mississippi Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2013-10-03 |
| 1467781377 | Grenada Lake Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2009-12-24 |
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184073181 | 81msgs/sgcq | General Acute Care Hospital | 81msgs/sgcq, 301 Fisher St, Rm 5a127, Keesler Afb, MS 39534 | 2016-06-09 |
| 1013396290 | Martin Hillard Mcmullan | General Acute Care Hospital | 2350 Cooper Rd, Flowood, MS 39232-6136 | 2015-05-21 |
| 1750771580 | Genesis Rehab | General Acute Care Hospital | 438 North St, Union, MS 39365-9506 | 2015-02-02 |
| 1003229469 | Robert J Cole | General Acute Care Hospital | 601 Meadowbrook Cir, Amory, MS 38821-1314 | 2014-06-03 |
| 1295151850 | Mary A. Doss | General Acute Care Hospital | 110 Napoleon Dr, Brandon, MS 39047-9004 | 2014-03-06 |
| 1467755744 | Biloxi Regional Medical Center | General Acute Care Hospital | 1104 Homestead Blvd, Gautier, MS 39553-4612 | 2010-12-08 |
| 1528371119 | University Physicians. Pllc | General Acute Care Hospital | 121 Beaufort Cir, Madison, MS 39110-7962 | 2010-07-23 |
| 1306047436 | Alliance Healthcare System | General Acute Care Hospital | 1430 Hwy4-east, Holly Springs, MS 38635 | 2007-05-29 |
| 1518168624 | Alliance Healthcare System | General Acute Care Hospital | 1430 Hwy 4 East, Holly Springs, MS 38635 | 2007-05-29 |
| 1043427206 | Alliance Healthcare System, Inc | General Acute Care Hospital | 1430 Highway 4 E, Holly Springs, MS 38635-2140 | 2007-05-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on GRENADA LAKE MEDICAL CENTER.
| 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.